Economic Burden of Illness in Canada, 2010

The Economic Burden of Illness in Canada (EBIC) is a comprehensive cost-of-illness (COI) study that provides estimates of the ... Skiptomaincontent Skipto"Aboutgovernment" EconomicBurdenofIllnessinCanada,2010 Downloadthealternativeformat (PDFformat,402 KB,65 pages) Organization: PublicHealthAgencyofCanada Datepublished:April 2018 Referenceas:2017.ThePublicHealthAgencyofCanada.TheEconomicBurdenofIllnessinCanada,2010 TableofContents Foreword Acknowledgements Introduction Cost-of-Illness TheSystemofHealthAccounts MethodsandDataSources DirectCosts HospitalCareExpenditures DrugExpenditures PhysicianCareExpenditures IndirectCosts ValueofLostProduction CaregivingCosts Results DirectCosts HospitalCareExpenditures DrugExpenditures PhysicianCareExpenditures IndirectCosts ValueofLostProductionduetoMorbidity ValueofLostProductionduetoPrematureMortality CaregivingCosts TotalCosts Limitations References Appendix:EBICDiagnosticCategories ListofFigures Figure1:ComponentsofCost-of-Illness Figure2:AllocatingExpendituresusingaTop-DownApproach Figure3:CurrentHealthExpendituresbyUseofFunds,Canada 2010($000,000) Figure4:CostliestICDchaptersbyhealthfunction,hospitalexpendituresonly,Canada 2010 Figure5:Percentageofhospitalexpendituresandpopulationbyagegroup,Canada 2010 Figure6:Percentageofhospitalexpendituresbyagegroupandhealthfunction,Canada 2010 Figure7:Inpatienthospitalexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure8:Percentageofinpatienthospitalexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure9:Daysurgeryhospitalexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure10:Percentageofdaysurgeryhospitalexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure11:Emergencydepartmenthospitalexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure12:Percentageofemergencydepartmenthospitalexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure13:Drugexpendituresbysex,selectedICDchapter,Canada 2010($000,000) Figure14:Percentageofdrugexpendituresandpopulationbyagegroup,Canada 2010 Figure15:Percentageofdrugexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure16:Physicianexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure17:Percentageofphysicianexpendituresandpopulationbyagegroup,Canada 2010 Figure18:Percentageofphysicianexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure19:Morbiditycostsbysex,selectedICDchapters,Canada 2010($000,000) Figure20:Percentageofmorbiditycostsandpopulationbyagegroup,Canada 2010 Figure21:Percentageofmorbiditycostsbyagegroup,selectedICDchapters,Canada 2010 Figure22:Prematuremortalitycostsbysex,selectedICDchapters,Canada 2010($000,000) Figure23:Percentageofprematuremortalitycostsandpopulationbyagegroup,Canada 2010 Figure24:Percentageofprematuremortalitycostsbyagegroup,selectedICDchapters,Canada 2010 Figure25:Caregivingcostsbytype,selectedICDchapters,Canada 2010($000,000) Figure26:Totalcaregivingcostsbysex,selectedICDchapters,Canada 2010($000,000) Figure27:Percentageoftotalcaregivingcostsandpopulationbyagegroup,Canada 2010 Figure28:Percentageoftotalcaregivingcostsbyagegroup,selectedICDchapters,Canada 2010 Figure29:PercentageofDirectandIndirectCostscomapredtoTotalCosts,Canada,2010 ListofTables Table1:NHEXCurrentExpenditures,Canada,2010($000,000) Table2:Datasourcesemployed Table3:SHAandNHEXtotalsbyhealthfunction Table4:Estimatedexpendituresaspercentageofactualexpenditures($000,000) Table5:DirectCostsbyICDchapter,Canada 2010 Table6:HospitalexpendituresbyICDchapterandhealthfunction,Canada,2010 Table7:IndirectCostsbyICDChapter,Canada,2010 Table8:TotalEBICCosts,Canada,2010 Foreword ThefirstversionoftheEconomicBurdenofIllnessinCanadawasreleased,byHealthCanada,in1991 Reference1.Severalversionshavebeenproducedsincethatdate,withtheresponsibilityshiftingtothePublicHealthAgencyinCanadain2004. Reference2 Reference3 Reference4TheEconomicBurdenofIllnessinCanada,2010containsthemostrecentcomparabledataontheeconomicburdenofillnessandinjuryinCanadabrokendownbydisease,age,andsex.ThefirstpartofthereportreviewsthemethodsemployedintheproductionofEBICwhilethesecondhalfpresentsasummaryoftheresults.UserswhorequireEBICdataatthelevelofdiagnosticcategoryaredirectedtowardstheEBICOnlineTool.Theonlinetoolprovidesdataonthedirectcostsandprematuremortalitycostsavailablebydiagnosticcategory,age,sex,andprovince. ThefirstversionofEBICcloselyfollowedthemethodologysetoutinonethemostsignificantcost-of-illness(COI)studies,byRice(1967).Reference5RecentyearshaveseenimportantmethodologicalrefinementstoCOImethodsandtoensurethatEBICcontinuestoproducevalidandreliablepolicy-relevantdata,thesechangeshavebeenincorporated,asappropriate.SomeofthemostnoteworthyrevisionsallowforincreasedinternationalcomparabilityofEBICresults.ThisincludesachangeindiagnosticcategorieswhicharenowbasedontheInternationalShortListofHospitalMorbidityTabulation(ISHMT)andInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems 10th Revision(ICD-10)chapters,aswellasacloseralignmentwiththeSystemofHealthAccounts(SHA).Reference6 Cost-of-illnessstudiessuchasEBIC,whichcovertheentireclassificationofdiseases(enablingmutualcomparisonofdiseasecostsintermsofresourcesusedandforegoneopportunities),providevaluableinformationforpolicyandplanningpurposes.Suchinformationcanhelpusunderstandchangesinpatternsofpracticewithrespecttoresourceutilizationandhelptoclarifythemostimportantcostcomponentsoftreatingspecificdiseases.ThedatacollectedforEBICcanalsobecombinedwithdataonoutcomesandinformeconomicevaluationsofhealthandhealth-carepolicies.EBICcostingdatacanalsobeutilizedinmodelingoffuturehealthcosts.Footnotea Acknowledgements TheEconomicBurdenofIllnessinCanada,2010waspreparedbythePublicHealthAgencyofCanada'sPopulationHealthEconomicsteam:AlanDiener,JacquelineDugas,KenEng,SameerRajbhandary,andIgorZverev. Acknowledgementisalsoduetotheorganisationsthatsuppliedthedata:theCanadianInstituteforHealthInformation,StatisticsCanada,provincialministriesofhealth,andIMSBrogan.Theanalyses,conclusionsandopinionsexpressedhereinaresolelythoseofthePublicHealthAgencyofCanada,andnotnecessarilythoseofthedataproviders. Introduction TheEconomicBurdenofIllnessinCanada(EBIC)isacomprehensivecost-of-illness(COI)studythatprovidesestimatesofthecost-of-illnessandinjurybydisease,age,andsex.TheprimarygoalofEBICistosupplyobjectiveandcomparableinformationonthemagnitudeoftheeconomicburden,orcost-of-illnessandinjury,inCanadabasedonstandardreportingunitsandmethods.EBICistheonlycomprehensiveCanadianCOIstudythatprovidescomparablecostinginformationforallmajorhealthconditions.EBICincludesinformationonthefollowingdirectandindirectcostcomponents: Directcosts Hospitalcareexpenditures Physiciancareexpenditures Prescriptiondrugexpenditures Dentalservicesandvisioncareservices Formalcaregiving IndirectCosts Lostproductionduetomorbidity Lostproductionduetoprematuremortality Informalcaregiving Supplementingotherhealthindicators,EBICprovidesreliableevidencetosupportpublichealthpolicyandprogramplanning.Expendituredata(directcosts)canprovideinformationonchangesinpatternsofpracticeandresourcetrendsovertimeoracrosssectors.Thus,itcaninformfutureallocationdecisionswithinthehealthcaresector.Also,whencombinedwithdataonoutcomes,thesedatacanbeanimportantinputforeconomicevaluationsofpoliciesandprogrammesandotheranalyses,withtheultimategoalofincreasingtheefficientuseofresources. Oneofthemostimportantusesofaggregateeconomicstatisticsinhealthcareinvolvestheirinternationalcomparison.EffortshavebeenmadetofollowtheOrganisationforEconomicCooperationandDevelopment’s(OECD)guidelinesonproducingexpenditure-by-diseaseestimatesundertheSystemofHealthAccountsFramework,inordertoderiveinternationallycomparableestimatesusingstandard,agreed-upondefinitions. Reference7Assuch,thedataareallocatedaccordingto InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems(ICD)Chapterand,whenpossible,tooneof185EBICdiagnosticcategoriesbasedontheInternationalShortListforHospitalMorbidityTabulation(ISHMT).Footnoteb Reference8WhilethesecategoriesdonotdirectlycorrespondtothecategoriesusedinpreviousversionsofEBIC,theyaremoreusefulfromapolicyperspectiveandthegoalistocontinuetoreportonthesecategoriesinfutureversionsofEBIC. TheinclusionofindirectcostsisanimportantcontributionofEBIC,andprovidesabetterunderstandingofsocietalcostsassociatedwithillness,whichisakeyconsiderationinundertakingpolicyanalysis.Therelativesizeofindirectcoststodirectcostsvariesconsiderablybytypeofillness,andthustheirinclusioncanresultindifferentconclusions.Thevalueoflostproductioncanbeconsideredtobethedecreaseineconomicproduction,orGrossDomesticProduct(GDP),asaresultofillnessorinjury. EBICfollowsaprevalence-basedapproach.Aprevalence-basedCOIstudyestimatestheannualcostsofallcasesofillnessexistinginagiventimeperiod,andcanprovideasnapshotatanygivenpointintime(e.g.year). TwonotablechangestothecurrentversionofEBICincludeafurtherelaborationofhospitalexpendituresbyhealthfunctionandtheinclusionofcaregivingcosts.Hospitalexpendituresarebrokendownbyinpatientcare,outpatientcare,daysurgery,andemergencydepartmentvisits.Theestimationofcaregivingcostswaspossibleasthe2012GeneralSocialSurveyincludedamoduleonCaregivingandCareReceiving,whichprovidedthenecessarydata.Caregivingcaneitherbeprovidedformallywithadirectpaymentmade,oritmaybeprovidedbyarelativeorfriendwithnopaymentmade.Asthelatterstillinvolvestheuseofresourceswhichcannotbeotherwiseemployed,theyareconsideredtobeanindirectcost.EBICincludesbothformsofcaregivingcosts.Havinginformationonthesecostscanprovideinsightintoanotheraspectofhealthpolicy. Cost-of-Illness TheEconomicBurdenofIllnessinCanadadoesnotaddressthetotalcostsofillness;ratheritfocusesonthedirectandindirectcosts–thatis,thosecostswhichhavedirectresourceimplications. Thedirectcostsfocusontheconsumptionofresourcesinthetreatmentofillnessandinjuryand,generally,refertothoseitemsforwhichsomeformofpaymenthasbeenmade,includingmedicalcareexpensessuchashospitalization,outpatientandphysicianvisits,long-termcare,drugs,medicalcare,formalcaregiving,equipment,etc. Theindirectcostsfocusonthoseresourceswhichareforegoneduetotheillnessorinjuryandthuscannotbeusedforotherpurposesbutinvolvenodirectpaymenttoserviceproviders.Theseincludelaboursupplyeffectssuchasthevalueoflostproductionduetoabsenteeismorpresenteeism(workingbutnotatfullproductivity)resultingfromdisabilityorprematuremortality,oranytypeofcaregivingwithoutaformalpayment. Togetherthesecostsgiveusinformationonthemagnitudeoftheresourceuserelatedtotheillnessorinjury.Whilethisinformationisanimportantconsiderationforplanningpurposes,itdoesnotpresenttheentireburdenassociatedwithillness. Illnessandinjurynotonlycreatesocietalcostsintheformofresourcesused,butalsointheformofhealthimpactsandlossoflife.Whileoutcomessuchasemotionaldistress,pain,lossoflife,andotherformsofsufferingasaresultofillnessandinjurycanbeconsideredacostofillness,theyareusuallynotincludedinCOIstudiesduetomethodologicalchallenges.Theseoutcomescan,however,beexpressedinutilitytermssuchasquality-adjustedlifeyears(QALYs)anddisability-adjustedlifeyears(DALYs),orinmonetarytermsusingvaluesobtainedfromstatedpreferencestudiesand/orvalueofastatisticallife(VSL)studies.Theseapproachesareoftenemployedineconomicevaluationanalysesandregulatorypolicyevaluations.AstheseadverseoutcomesarenotincludedinEBIC,theresultscanbeconsideredasanunder-estimationofthetotalmagnitude. Figure1providesabreakdownofthedifferentcomponentsthatcanbeincludedinCOIstudies. TheSystemofHealthAccounts TheOECD’srecentguidelinesonestimatingexpendituresbydisease,ageandsex,provideasystematicapproachforestimatingthedirectcostsofillnessundertheSystemofHealthAccounts(SHA)framework. Referencef Referenceg Reference9Thisallowsfortheestimationofinternationallycomparablecostofillnessestimates.AstheSHAprovidesasingleglobalframeworkforproducinghealthexpenditureaccountsitprovidesausefulstartingpointandcommonsetofdefinitionsrelatedtotheproductionandconsumptionofthehealthcareservicesincludedinEBIC. TheSHAisfoundedonatri-axialrelationshiptrackingtheflowofallhealthcaregoodsandservicesaccordingtotheirconsumption,provisionandfinancing.Withrespecttoconsumption,theSHAtracksexpendituresbyhealthfunctionsfocusingonthepurposeofthegoodsandservicesbeingconsumed.Healthcareprovidersencompassorganizationsthatdeliverhealthcaregoodsandservicesastheirprimaryactivity,aswellasthoseforwhichhealthcareprovisionisonlyoneamonganumberofactivities.Thefinancingcomponentfocusesonthesourceoffunds.EBICfocusesonlyontheproviderandconsumptionclassificationsasthesearethemostrelevantfromapolicyandplanningperspective. WhiletheSHAprovidesasystematicframeworkforallocatingallhealthcareexpendituresaccordingtoalloftheclassificationtypes(provider,function,financing),thelevelofdetailisdependentonavailabilityofdatainaparticularcountry.InCanada,datasourcesaregenerallylinkedto,oravailableby,thetypeofhealthproviderwithlimitedinformationonthehealthfunction.MoredetailsareprovidedintheMethodsandDataSourcessection. Figure 1:ComponentsofCost-of-IllnessFigure 1notea Direct TransferpaymentsFigure 1noteb Indirect HealthOutcomes Directresourceuseorconsumption Expendituresforwhichadirectpaymentwasmade Medicalgoodsandservicessuchas:hospitalservices,doctors,nurses,drugs,diagnostics,ambulatorycare,rehabilitation,long-termhealthcare,etc. Formalcaregiving Expenditureonothergoodsandservices–suchaspolicingandcriminaljusticecostsassociatedwithsubstanceabuse Paymentsmadeforinabilitytoworkduetoillness(e.g.fromgovernmentorsocialinsurance.Purposeisincomemaintenance) Allowancespaidforhouseholdproductionofhealthcare(e.g.bygovernmentorsocialinsurance) Foregoneresourcesoropportunities Formallabourmarketeffectsduetomorbidityandprematuremortality E.g.absenteeismandpresenteeism Informalcaregiving Painandsuffering Valueoflife Figure1notea Notethatsomegreyareasmaystillexist,orthepossibilityofoverlap,whenconsideringthecomponentsofCost-of-Illness. Returntofigure1noteareferrer Figure1noteb NotincludedinCOIfromthesocietalperspectiveasthesepaymentsaretransferredfromonesectoroftheeconomytoanother. Returntofigure1notebreferrer MethodsandDataSources DirectCosts EBICemploysatop-downapproachwheretotalhealthexpendituresareallocatedacrossdiagnosticcategories(basedonICD-10andISHMT),age,sex,andprovince/territory.Inatop-downapproach,actualhealthexpenditures,oftentakenfromnationalhealthaccountingdata,areusedasthestartingpoint,andexpendituresareallocatedacrossdiseasegroups,usinganallocationorutilizationkey(seeFigure 2).Oneofthebenefitsofthisapproachisthatexpenditurescanonlybeallocatedonce,avoidinginstancesofdoublecounting. Figure 2:AllocatingExpendituresusingaTop-DownApproach Figure 2 –Textdescription Currenthealthexpenditurescanbebrokenintoseveralcategoriesaccordingtoprovidertypeortypeofcareprovided.Thesecategoriesinclude: Hospitals,includingin-patient,out-patient,general,andspecializedcare Physicians,includinggeneralpractitionersandspecialists Drugs,includingprescriptionandnon-prescription Otherhealthcareproviders,includingdentistsetc. Otherhealthspending,includingadministration,publichealth,etc. Aspreviouslynoted,directcostsincludealltransactionsforwhichsomeformofpaymentwasmade.TheNationalHealthExpenditureDatabase(NHEX)containssummaryexpendituredatafrompublicandprivatesourcesbrokendownbythefollowingcategories:hospitalsandotherinstitutions,physiciansandotherprofessionals,drugs,publichealth,andotherhealthspending. Reference10NotethatwhileNHEXalsoreportsexpendituresoncapitalformation,EBIConlyfocusesoncurrentexpendituresinordertobeconsistentwiththeOECDandSHAguidelines.Table 1showscurrenthealthexpendituresforCanadain2010byuseoffunds. Table 1:NHEXCurrentExpenditures,Canada,2010($000,000) HealthFunction Expenditures HospitalsTable 1notea $56,734 Otherinstitutions $19,991 PhysiciansTable 1notea $27,445 OtherProfessionals $18,853 DentalServicesTable 1noteb $11,885 VisionCareServicesTable 1noteb $3,913 Other $3,055 Drugs $32,407 PrescribedDrugsTable 1notea $27,565 Non-PrescribedDrugs $4,842 Publichealth $9,847 Administration $5,817 OtherHealthSpending $11,966 HealthResearch $3,409 $8,557 GrandTotal $183,059 Source:NHEX2015 Table1notea Expendituresthatcouldbeallocatedbydisease. Returntotable1noteareferrer Table1noteb VisionCareandDentalServicescouldonlybeallocatedattheICDchapterlevel. Returntotable1notebreferrer InCanada,totalcurrenthealthexpenditures,in2010,were$183.1 billion.ForEBIC,itwaspossibletoallocate$127.6 billion(70%)attheICDchapterlevel;thisaccountedforexpendituresonhospitals,physicians,dentalservices,visioncareservices,andprescriptiondrugs.ItwasnotpossibletoallocatedentalandvisioncareservicesbeyondtheICDchapterlevel.AttheEBICdiagnosticcategorylevel,itwasonlypossibletoallocatehospital,physician,andprescriptiondrugexpenditures,accountingfor61%,or$111.8 billion,ofallhealthexpenditures. Inordertoallocatetheexpenditurestodiagnosticcategoriesitisnecessarytohavesomeformofallocationkey.Severaladministrativedatabaseswereemployedforthispurpose.Asthisdatawasgenerallyprovidedaccordingtoprovidertype,thespecificmethodsarepresentedbyprovidertype.Ingeneral,patient-leveldatawasemployed,whichinatop-downframeworkincreasestheusefulnessoftheresultsastheymoreaccuratelyrepresenttheactualresourceimplicationsattributedtodifferentdiseases. HospitalCareExpenditures HospitalexpendituresincludeallcostsassociatedwithoperatingandmaintainingbothpublicandprivatehospitalsinCanada:drugsdispensedinhospitals,medicalsupplies,therapeuticanddiagnosticoutpatientcosts,administrativecosts,someresearchcosts,accommodationandmealsforpatients,maintenanceofhospitalfacilities,andgrosssalariesandwagesforallhospitalstaff(suchasphysiciansonhospitalpayroll,nurses,techniciansandmedicalstudents). Referencej Thefollowingdatabaseswereusedtoallocatecostsbydisease: DischargeAbstractDatabase(DAD):TheDADcontainsinformationonhospitalseparations(discharges,deaths,sign-outsandtransfers)frommosthospitalsinCanada,excludingQuebec.Thisincludesdatarelatedtoallacuteinpatientstays,daysurgerydataformostprovinces/territoriesandsomedataonchronic,rehabilitationandpsychiatrichospitalseparations. Reference11 Reference12TheDADcontainsapproximately75%ofallinpatienthospitalseparations.ThisaccountsformostoftheinpatientexpendituresoutsideofQuebec. HospitalMorbidityDatabase(HMDB):TheHMDBisanationaldatabasethatcontainsinformationonallacuteinpatienthospitalseparations.However,theHMDBholdsinformationonQuebecacuteinpatientseparationsandexcludesalldaysurgeryrecords. Reference13 Reference14 NationalAmbulatoryCareReportingSystem(NACRS):TheNACRScontainsrecordsofallOntarioambulatorycareseparations(daysurgery,emergencydepartment,clinicsandotherambulatorycare),aswellassomeambulatorycareseparationsforseveralotherprovinces/territories. Reference15 Reference16 DaysurgeryabstractsaresubmittedtoboththeDADandNACRS(dependingontheprovince/territory),withapproximately64%senttoNACRSand36%senttotheDAD.Footnotec HospitalMentalHealthDatabase(HMHDB):TheHMHDBcontainsinformationonallOntariopsychiatrichospitalseparationsandonallseparationsfromdesignatedadultpsychiatricbedsinOntariogeneralhospitals.Theinformationispartialforotherprovinces/territories. Reference17 Reference18TheHMHDBalsoholdsinformationobtainedfromtheDADandtheHMDBonallgeneralhospitalseparationswithaprimarydiagnosisofmentalillness.Thus,theHMHDBholdsallavailabledataonmentalhealthseparations. EstimatingCosts Thedatabasescontainuptotwenty-fivepossiblediagnosesforeachseparationrecordedasanICD-10,ICD-9,oraDSM-IVcode,usuallyatthefive-digitlevel.Eachrecordnotesthemostresponsiblediagnosis,whichisdefinedas“thediagnosisorconditionthatcanbedescribedasbeingmostresponsibleforthepatient’sstayinhospital.Ifthereismorethanonesuchcondition,theoneheldmostresponsibleforthegreatestportionofthelengthofstayorgreatestuseofresourcesisselected.” Reference19 CostdatawasprovidedforeachhospitalseparationintheDAD,theNACRS,andtheHMHDB,makingitpossibletoallocatehospitalexpendituresbydisease,age,andsex.Therearegenerallytwomethodsforderivingcostsusingdischarge-leveldata:theperdiemmethodoremployingresourceintensityweights.Undertheperdiemmethod,thehospitallengthofstayismultipliedbytheaveragedailyhospitalcost,whichcanbecalculatedattheindividualhospitalorregionallevel.Whilethenumberofhospitaldaysmaybeagoodindicatorforpartofthehospitalcare,usingonlydataonlengthofstaywouldnottakeintoaccountthetypeofcarereceived.Forexample,thereisalargecostdifferentialbetweenadayspentinageneralwardversusadayspentinintensivecare.Inaddition,certaindiseasesrequiremoreexpensiveandresource-intensivetreatment.Forthesereasonstheperdiemmethodmaynotprovideanaccuratecostestimate. Inordertoderivecostsbasedonactualresourceintensity,CIHIprovidedaresourceintensityweight(RIW)andacostperweightedcase(CPWC)foreachseparationintwooftheirdatasets,theDADandtheNACRS.RIWsprovideameasureoftheintensitywithwhichhospitalresourceswereusedbyeachpatient.SeveralfactorswereconsideredinCIHI’scalculationofRIWvalues:casemixgroup,age,comorbidity,anumberofflaggedinterventions,interventionevent(s),out-of-hospitalinterventionandpossibleinteractions. Reference20Thus,usingRIWsallowsforamorereliablemethodofallocatingexpendituresbydiseaseasittakesintoaccountthatpatientsutilizevariousintensitiesofresourcesduetopatientcharacteristics,primarydiagnosesandtreatments.TheRIWsweremultipliedbytheCPWCtoobtaintherecord-levelcost.Astherewasnoinformationastohowmucheachoftherecordeddiagnosesmayhaveaddedtotheexpendituresassociatedwiththatseparation,allcostswereattributedtothehealthconditiondefinedasthemostresponsibleforthehospitalstay. Inordertoestimateexpendituresassociatedwithseparationscontainedintheotherdatabases,averagecostsbydiagnosticcategory,age-group,andsexwerederivedusingtheDADandappliedtothedatafromtheHMDBandtheHMHDB.Oncecostswerederivedforeachhospitalseparation,thesecostswerethenaggregatedoverdiagnosticcategoriesandICDchaptersbysex,agegroup,andprovince/territory.(Notethattheper-diemcostinginformationandtheRIWusedifferentmethodologiesandincludedifferentcostingcomponents,makingthetotalcostsusingeachmethoddifferent.Thus,whiletheHMHDBcontainedper-diemcostinginfo,theaforementionedmethodologywasemployedforconsistencypurposes.) Table 2containsinformationonthecoverageofthedatasetsemployedintheestimationofhospitalexpendituresbydisease. Table 2:Datasourcesemployed Database Geographicalcoverage Healthfunctioncoverage Diagnosticcategoriescovered Resourceintensityweight(RIW)orperdiem DischargeAbstractDatabase(DAD) AllofCanada,excludingQuebec Inpatient DaySurgery All RIW HospitalMorbidityDatabase(HMDB) AllofCanada,includingQuebec Inpatient All N/A NationalAmbulatoryCareReportingSystem(NACRS) PredominantlyOntarioandAlberta LimiteddatafromafewotherP/Ts ExcludesQuebec DaySurgery Outpatient-clinics Outpatient-ED All RIW HospitalMentalHealthDatabase(HMHDB) AllofCanada,excludingQuebec.(Includespsychiatricfacilitiesandmentalhealthdiagnosesinotherhospitals) Inpatient AllTable 2notea Perdiem Table2notea TheHMDBcontainsdataonallseparationswithamostresponsiblediagnosiswhichfallsunderICDChapter V,MentalandBehaviouralDisordersaswellasseparationsfrommentalhealthhospitals.TheformerseparationsarealsoincludedintheDAD,thusonlythoseseparationsthatwereuniquetotheHMHDBwereemployedbyEBIC. Returntotable2noteareferrer WhileNHEXprovidesdatabyuseoffunds,thecategoriesemployedfocusmoreontheprovidertypethanthehealthfunctionrelatedtothetypeofcare.Forexample,hospitalsprovideseveraldifferenttypesofcareincludinginpatient,andvarioustypesofdayandoutpatientservices.Theseservicesshouldbeexaminedseparatelyastheyvarysubstantiallyinhowcareisprovided,theresourcesusedandthetypesofhealthconditionstreated.FollowingtheSystemofHealthAccounts(SHA),hospitalexpenditureswerefurtherbrokendownbythefollowingfunctions:inpatientcare,daysurgery,outpatient-clinic,emergencydepartmentvisits,andother(includeshome-basedcare,long-termcare,preventivecare,andancillaryservices).FootnotedNotethatthesecategoriesdonotexactlymatchtheSHAfunctionalcategories,whichfirstdistinguishbetweencurative(HC.1)andrehabilitativecare(HC.2),astheCanadiandatacombinesthesetwocategories. AlthoughboththeSHAandtheNHEXarebothhealthaccountingframeworks,andcoverthesamesetsofexpenditures,duetodifferencesindefinitionsemployed,theexpendituretotalsundereachframeworkareslightlydifferent.Forexample,hospitalexpendituresintheSHAdonotincludecertainexpendituresonsuchitemsasresearch,trainingofhealthworkers,pastoralcare,orsocialwork.In2010theseitemsaccountedfor$2.8 billion;theNHEXhospitalexpendituretotal(andtheoneusedinEBIC)was$56.7 billionwhereastheSHAhospitalexpendituretotalwas$53.9 billionFootnotee. Table 3showstheSHAtotalsforallhospitals(HP.1)brokendownbyfunction.InordertoallocatetheNHEXhospitalexpendituretotalacrossfunctions,theSHAdistributionwasemployed.Forexample,52%oftheSHAexpenditureswereallocatedtowardsinpatientcare.Applyingthispercentageresultsinanestimateof$29.5 billionforinpatientcare,accordingtotheNHEX(andEBIC)totalforthehospitalcategory.Theexpenditurevaluesfortherestofthefunctionswereestimatedinthesameway. Table 3:SHAandNHEXtotalsbyhealthfunction SHAFunction TypeofCare SHAexpenditures ($000,000) Percentageoftotalhospitalexpenditures(usingSHA) NHEXexpenditures ($000,000) HC.1.1&HC.2.1 InpatientCurativeandRehabilitativeCare 28,000 52.0% 29,500 HC.1.2&HC.2.2 DayCurativeandRehabilitativeCare 7,300 13.6% 7,700 HC.1.3&HC.2.3 OutpatientCurativeandRehabilitativeCare 14,100 26.2% 14,900 HC.1.4&HC.2.4 Home-basedCurativeandRehabilitativeCare 200 0.4% 0,200 HC.3 Long-termCare 3,600 6.7% 3,800 HC.4 AncillaryServices(not-specifiedbyfunction) 300 0.6% 300 HC.5 MedicalGoods(not-specifiedbyfunction) 0 0% 0 HC.6 PreventiveCare 300 0.6% 300 HC.7 Governance 0 0% 0 Allhospitals(HP.1) 53,900 100% 56,700 Source:OECD(2017) Reference21andCIHI(2015) Referencej Whiletheabovedatabasescontainadministrativedata,completionisnotmandatoryforalltypesoffunctionsinalljurisdictions.Hence,thetotalestimatedvalueofallexpendituresaccountedforinthesedatabaseswasjustover$33.1 billion,or58%ofthetotalvalueofhospitalexpendituresaccordingtoNHEX($56.7 billion).Table 4showsthetotalvalueofexpendituresderivedfromtheadministrativedata(i.e.separations),comparedtotheNHEXdata,brokendownbyhealthfunction. Notethatoutpatientcarehasbeenfurtherbrokendownintoemergencydepartment(ED)visitsandclinicvisits.Outpatientcareiscomprisedofthoseservicesdeliveredtoapatientwhoisnotformallyadmittedtoafacilityanddoesnotstayovernight.Thiscoversemergencydepartment(ED)visitsaswellasotherservicesthatcanbebroadlydefinedasclinic-typevisits.TheSHAdoesnotprovideanyinformationonafurtherbreakdownofthiscategory.However,accordingtoCIHItheDADandNACRScontain50%ofallEDexpenditures.Thus,thetotalvalueofEDvisitswasestimatedbydoublingthevalueobtainedinthosetwodatasets.The“other”categoryincludeshome-basedcare,long-termcare,ancillaryservices,andpreventivecare.Duetodatalimitations,itwasnotpossibletoprovideresultsatamoregranularlevel. Itisevidentthatthepercentageofexpendituresaccountedforvariedbyfunction.Forexample,itwaspossibletoaccountfor90%ofinpatientexpenditures,butonly16%ofoutpatientclinicexpendituresusingtheseparationdatafromtheaforementioneddatabases.Inordertoestimatethedifference,theaveragecostsbydiagnosticcategorywereappliedadjustingforage-groupandsex.Toensurethattheexpendituresacrossprovincesremainedcorrect,thiswasrepeatedforeachprovinceandfunction. Table 4:Estimatedexpendituresaspercentageofactualexpenditures($000,000) HealthFunction NHEXexpenditurestotalbrokendownbySHAallocation ($000,000) Estimatedexpendituresfromseparationsdata ($000,000) %ofexpendituresaccountedfor Inpatient(HC.1.1&HC.2.1) $29,482.4 $26,559.5 90% Daysurgery(HC.1.2&HC.2.2) $7,723.7 $2,284.8 30% Outpatient-Emergencydept.Table 4notea $4,075.2 $2,035.2 50% Outpatient-ClinicTable 4notea $10,782.8 $1,746.9 16% OtherTable 4noteb $4,669.8 $539.0 12% Total $56,733.9 $33,165.5 58% Table4notea TogethertheseincludeHC.1.3andHC.2.3 Returntotable4noteareferrer Table4noteb includesHC.1.4,HC.2.4,HC.3,HC.4,HC.5,HC.6,HC.7 Returntotable4notebreferrer Source:CanadianInstituteforHealthInformation,NationalHealthExpenditureTrends,1975to 2015,DischargeAbstractDatabase,HospitalMorbidityDatabase,HospitalMentalHealthDatabase. DrugExpenditures Drugexpenditureestimatescomprisepublicandprivatecostsassociatedwithprescriptiondrugspurchasedinretailstores.Estimatesrepresentthefinalcoststoconsumers,includingdispensingfees,markupsandappropriatetaxes.DrugsdispensedinhospitalsandotherinstitutionsareexcludedastheyarecapturedunderthehospitalcareexpenditurescostcomponentofEBIC.Onlyprescriptiondrugexpenditurescouldbeallocatedbydisease,age,andsex. DatawereobtainedfromtwoIMSBrogandatasets:CompuScript(CS)andtheCanadianDiseaseandTherapeuticIndex(CDTI). Reference22 Reference23TheCScontainsinformationontotalprescriptiondrugcostsfornearly70%ofallpharmaciesacrossCanada,includingretailpriceanddispensingfees,andtotalvolumeofprescriptionssoldinretailpharmaciesacrossCanada,excludingtheterritories. TheCDTIisasurveythatprovidesinformationonthedrugprescribingpatternsofapanelofoffice-basedphysiciansacrossCanada Referencev.Itcollectspatientdemographiccharacteristics(e.g.sexandage),diagnosis(codedusingICD-9)anddrugsprescribed,therebyprovidingamappingfromdrugnamestodiagnoses,accordingtopatientcharacteristics.Assuchitservesthepurposeofautilizationkeyintheallocationofdrugexpenditurestodiagnosticcategory,age,andsex. TheCDTIusestheUniformClassificationSystem(USC),acategorizationsystemdevelopedbyIMSBrogan,tostandardizeandcategorizealldrugsaccordingtoproducttypeandtherapeuticclass.TheUSCisusedbyIMSBroganinNorthAmericaandclassifiesdrugsbasedontherapeuticcategory,thedrug’spharmacology,chemicalstructure,andindications.ItissomewhatsimilartotheAnatomicalTherapeuticClassification(ATC)systemdevelopedbytheWorldHealthOrganization. TheCDTIdataforthePrairies(Manitoba,Saskatchewan,andAlberta)andMaritimes(NewfoundlandandLabrador,NovaScotia,PrinceEdwardIsland,NewBrunswick)aregroupedasregionsinsteadofbyindividualprovince.Thus,eachprovincewithinaregionwasassumedtohaveasimilardistributionofdrugexpendituresacrossage,sex,anddiagnosticcategory.TheCDTIdoesnotincludedatafortheterritories. PhysicianCareExpenditures Physiciancareexpendituresincludeallfee-for-service(FFS)paymentsmadebyprovincial/territorialmedicalcareinsuranceplanstophysiciansinprivatepracticeaswellaspaymentsmadethroughalternativepaymentplans(APP),suchassalaries,sessionalfees,andcapitation.Physicianexpendituresdonotincludeexpendituresfornon-traditionalpractitionersandotherhealthcareprofessionals,whichwereincludedundertheNHEXcategoryAdditionalDirectHealthCareExpenditures,nordidtheyincludehospital-basedphysiciancareexpenditureswhichwereincludedintheHospitalCareExpenditurescategory. Referencej Currently,onlyphysicianFFSdatacontainsthenecessaryinformationtoallocatetheexpendituresbydiagnosticcategory,ageandsex.AsphysicianFFSdatawereonlyavailableforOntario,Saskatchewan,Alberta,andBritishColumbia,theywereemployedtoderivethephysiciancareexpendituresfortheotherprovincesandterritoriesusingage-adjustedaveragevalues.ThisapproachassumesthatthesefourprovincesarerepresentativeofthewholeCanadianpopulation.Whileincludinglessthanone-halfofallCanadianjurisdictions,theseprovincesaccountforabout65%ofthetotalpopulation. Provincial/territorialFFSphysicianbillinginformationwasusedtodistributetheamountbilledacrossdiagnosticcategories,agegroupandsex.Averageexpendituresfordiagnosticcategoryadjustedforage-groupandsexwerederivedandthisinformationwasusedtoestimatethedifferencebetweentheexpendituretotalsfromtheFFSdataandthetotalsincludedinNHEX.Footnotef IndirectCosts ValueofLostProduction Illnessandinjurymayresultinproductionlossestosocietyasawhole,eitherasaresultofmorbidityorprematuremortality.Thiscanincludelossesrelatedtobothpaidandunpaidlabour.Thetwomainimpactsonpaidlabourare:(i)absenteeism,whereastheresultofillness,orprematuredeath,aworkermaymisstimefrompaidwork;and(ii)presenteeism,whereanillworkermaystillshowuptoworkbutoperateatalessthanoptimallevel.FootnotegExamplesofpresenteeismcouldincludeamildillness,ortherecoveryperiodafteranabsence.Unpaidlabourincludescaregiving,volunteerwork,householdactivities,oranyotheractivitythatisoutsideofthestandardlabourmarket.Duetoinsufficientdataonpresenteeismandunpaidlabour,EBIC2010includesonlyestimatesofproductionlossesduetoabsenteeismasaresultofmorbidityandprematuremortality. Whenestimatingthevalueoflostproduction,itisnecessarytofirstmeasuretheamountoftimefromworkmissed,andthentovaluethisestimateusingaproxyforthevalueofthatproduction.Therearetwogenerally-acceptedapproachesusedtoestimatetheperiodoflostproduction–thehumancapitalmethod(HCM),andthefrictioncostmethod(FCM). TheHCM,usedbyearlierCOIstudies,estimatestheproductionlossesduetopermanentdisabilityormortalityforagivenyearasthevalueofanindividual’spotentialfutureearningsaccruedtotheexpectedageofretirement. ReferenceeThismethodisbasedontheassumptionofzeroinvoluntaryunemploymentor,inotherwords,itimplicitlyassumesthatwhenapersondiesheorshecannotbereplaced.Thisassumptionislikelytobeuntrueintoday’slabourmarket,asevidencedbyanunemploymentratethathasnotfallenbelow6%sincethe1970s(otherthanabriefperiodinlate2007andearly2008).Thus,theHCMislikelytooverestimatethetruevalueoflostproduction. Morerecently,researchersfromErasmusUniversitydevelopedtheFCM. Reference24 Reference25 Reference26Thismethodallowsfornon-zeroinvoluntaryunemployment,andassumesthatafterapersonleavesajobduetomorbidity,orprematuremortality,theywillbereplacedbyaworkerwhowaspreviouslyunemployed.Thetimeittakesforthenewworkertofindthejobandbeproperlytrainedisreferredtoasthefrictionperiod.Specifically,thefrictionperiodisconsideredtostartwhentheindividualleaveshisorherjob,duetoillnessorinjury,andtoendwhenthejobvacancyorchainofvacanciesarefilled. IntheFCM,lostproductivityduetomorbidityorprematuremortalityshouldnotextendbeyondthefrictionperiod.Forshort-termabsencesfromwork,theindividual’slostproductionmaybepartlyrestoredbytheindividualwhenheorshereturnstowork,orbythecompany’sinternallabourresources.Whenthetimelostfrompaidworkisshort,theestimatesfromthetwomethodsmaynotbedifferent.Forlongerperiods,theFCMwillresultinalowercostestimatecomparedwiththeHCM.TheFCMisconsistentwiththesocietalmethodandhasbeenrecommendedbytheCanadianAgencyforDrugsandTechnologiesinHealth(CADTH)intheirguidelinesfortheEconomicEvaluationofHealthTechnologies. Reference27 Reference28 ItisimportanttonotethattheHCM,withitsstrongassumptions,generateswhatcouldbeconsideredastheupperboundofthevalueoflostproductionduetomortality,whereastheFCMcanbeconsideredasthelowerbound,andthusamoreconservativeestimateofthevalueoflostproductionduetomortality. VacancydurationdatawasemployedbyKoopmanschapandvanIneveld(1992)andKoopmanschapetal.(1995)toestimatethefrictionperiodfortheNetherlands. Referencey ReferencezAssimilardatawasnotavailableforCanada,provincialaverageunemploymentdurationwasusedasaproxyforthefrictionperiod.Unemploymentdurationdatawerenotavailablefortheterritories,andsothenationalaverageunemploymentdurationwasusedasaproxy.Theunemploymentdurationusedintheanalysisrangedfrom13.6weeksto22weeks.Thisisconsistentwithfrictionperiodsemployedintheliterature. Reference29 Reference30 TheFCMwasfirstemployedbyEBICinthe2005-2008version.GiventhedifferencesbetweentheHCMandtheFCM,estimatesfromtheseEBICReportsshouldnotbecomparedwithestimatesfrompreviousEBICversions.Koopmanschapetal.estimated1988mortalitycostsfortheNetherlandsusingbothmethodsandfoundthatmortalitycostswere53timeshigherusingtheHCM. Referencey Thevalueoflostproductionwasestimatedfortheworking-agepopulationusingtheappropriateage-sex-province-specificearnings. Reference31Asearningsdatafortheterritorieswerenotavailable,correspondingnationalaverageswereused.Inordertotakeintoaccountthosenotinthelabourforce,theresultsweremultipliedbytheappropriatesex-age-province-specificemploymentrate. Reference32 Asaresultofincreasedabsencesanddecreasedproductivity,illnesscanaffectanindividual’semploymentprospectsandearnings.Thosewithchronicdiseasearelikelytohaverecurrentsickleave,long-termabsencesfromwork,andoftenfaceanearlyretirementfromthelabourforce.RecentresearchhasfocusedonestimatingthesemorepreciselabourmarketimpactsandwhiletheseareimportantconsiderationstheyarecurrentlybeyondthepurviewofEBIC. Reference33 ValueofLostProductionduetoMorbidity StatisticsCanada’s2010CanadianCommunityHealthSurvey(CCHS)LossofProductivity(LOP)modulewasusedtoestimatemissedworkdaysduetoillnessandinjury. Reference34TheCCHSisacross-sectionalsurveythatcollectsinformationrelatedtohealthstatus,healthdeterminantsandhealthcareutilizationfortheCanadianpopulation. Reference35 ForEBIC2010morbiditycostestimates,theperiodoflostproductionincludedmissedworkdaysduetochronicandacuteconditions.Specifically,CCHSrespondentswereaskedaboutmissedworkdaysduetoillnessorinjurywithinthe3monthperiodpriortothesurvey.IntheCCHSLOPmodule,chronicconditionsaredefinedasalong-termphysicalormentalconditiondiagnosedbyahealthprofessionalthathaslastedorisexpectedtolast6monthsormore.ForthepurposeofEBIC2010analyses,respondentswhoparticipatedinthe2010CCHSLOPmoduleweregroupedintothefollowingthreecategoriesaccordingtotheirresponsestoparticularsurveyquestions:missedlessthan90daysofworkduetoillnessorinjuryinthepast3months;missed90consecutivedaysofworkduetoillnessorinjuryinthepast3monthsbuthadworkedinthepast12months;andexcludedfromanalysis.Footnoteh Forrespondentswhoreportedmissinglessthan90daysduetoillnessorinjuryinthepast3months,theexactnumberofdaysmissedmultipliedbyfour(toreflecttheentireyear)wasusedastheperiodoflostproduction.Forrespondentswhoreportedmissing90consecutivedaysofworkduetoillnessorinjuryinthepastthreemonthsbuthadworkedinthepast12months,theestimatedfrictionperiod(theunemploymentduration)wasemployed.Astheserespondentsindicatedthattheyhadworkedinthepast12months,itwasassumedthattheirfrictionperiodfellwithintheyearandthattheywerereplacedafterthedurationofthefrictionperiod.Allrespondentswhoindicatedthattheyhadnotworkedinthepast12monthswereexcludedfromtheanalysis,asthefrictionperiodandlostproductionfortheseindividualswouldhavefalleninanotheryear. EstimatedmissedworkdaysfromtheCCHSwereallocatedtoEBICdiagnosticcategoriesaccordingtothephysicalandmentalhealthconditionsidentifiedbyrespondents.GiventhatindividualswereonlyaskedaboutbroadgroupsofillnessorinjuryintheCCHS,EBIC2010estimatesforthevalueoflostproductionareonlyavailableattheICDchapterlevel.Inaddition,StatisticsCanadaguidelinesrestrictthereleaseofdatabasedonsmallcellcountswhichalsoaffectedthewaysinwhichthedatacouldbegrouped.Therefore,morbiditycostestimatesareonlyavailablebylargerage-groups(15-34 years,35-54 years,and55-75 years).FootnoteiItwaspossibletoallocate73%ofthemorbiditycoststoanICDchapter;theremainderwaslabelledasunallocated. NotethatmethodsusedtoproducetheseestimatesaretheexactsamemethodsusedtoestimatethevalueoflostproductionduetomorbidityinEBIC2005-2008.Theonlydifferenceisthatinformation(intheformofICDcodes)fortheCCHS2010LOP_050“OtherSpecify”questiononhealthconditionwasobtainedfromStatisticsCanada.Thisallowedtheunallocatedportionofmorbiditycoststobereducedby$2.0 billion. ValueofLostProductionduetoPrematureMortality Inordertobeconsistentwithaprevalence-basedCOIapproach,alllostproductionthatwouldhaveoccurredin2010,ifitwerenotfortheexistenceoftheillness,orinjury,shouldbeincluded.Thiswouldentailgoingbacktothefinalmonthsof2009todeterminewhichofthoseprematuredeathscontributedtolostproductionin2010.Thelengthoftimetogobackisdependentontheappropriatefrictionperiod.For2010,thedurationofunemploymentrangedfrom13.6weeks(3.1months)to22weeks(5.1months). DatafromStatisticsCanada'sVitalStatisticsDeathDatabase(2010)wereemployedtoestimatethevalueoflostproductionduetoprematuremortality.ThisdatabasecontainsinformationonalldeathsthatoccurredinCanada,includingdateofdeath,causeofdeath(codedusingICD-10),age,sex,andprovince/territoryofresidence.Thevalueoflostproductionin2010wasestimatedbymultiplyingthenumberofdeathsbythefrictionperiod,thelabourforceparticipationrate,andaveragemonthlyearnings(usingage-sex-province-specificrates).ThecostswerethenallocatedtoEBICdiagnosticcategoriesbasedontheICD-10codedcauseofdeath.Thevalueoflostproductionwasestimatedfortheworkingagepopulationcomprisingindividualsaged15-64 years,brokendownbythefollowingagegroups:15-34 years,35-54 years,and55-64 years.FootnotejTheresultsexcludedmortalitycostestimatesforresidentsofotherprovinces/territorieswhodiedinQuebec. CaregivingCosts Caregivingcanbeclassifiedaseitheradirectcostoranindirectcostdependingonwhetheraformal,ordirect,paymentwasmade.Caregivingcostswereestimatedfor2010usingdatafromtheGeneralSocialSurvey(GSS)Cycle 26:CaregivingandCareReceiving.Reference36Thesurveyincludedquestionsaboutanycarereceivedbytherespondentforahealthconditionoraging,intheprevioustwelvemonths,andthemainconditionforwhichtherespondentsoughthelp.Caregivingwasseparatedintotwogeneralgroups:caregivingprovidedbyfamily,friendsandneighbours,andcaregivingprovidedbypaidworkersandorganizations.ForthepurposeofEBIC2010,theformerhasbeenclassifiedasinformalcaregiving(indirectcosts)andthelatterasformalcaregiving(directcost). Cycle 26oftheGSScontainsdatafortheyear2012,soadjustmentsweremadeforpopulationdifferences.ThetargetpopulationforCycle 26oftheGSSincludedallpersons15 yearsofageandolderinCanada,excludingresidentsoftheYukon,NorthwestTerritories,andNunavut,aswellasfull-timeresidentsofinstitutions. Caregivingtimewasvaluedusingthecaregiver’scharacteristicsandattributedtotherespondent’s(personreceivingthecare)characteristics.Respondentswereaskedaboutthetotalnumberofhoursofcarereceivedperweek.Thetotalcaregivinghoursweremultipliedbytheappropriateearningsforthecaretakerbasedonprovince,age,andsex.Footnotek,Footnotel,FootnotemAnnualaverage2010province-sex-agespecificearningswereobtainedfromCANSIM.Footnoten Reference37Dataonthecaregiver’sageandsexwerenotavailableforformalcaregiving,thusprovincialspecificearningswereemployed.Thesecostswerethenallocatedtotherespondent’ssexandagegroup,andmaincondition(ICDchapter)forwhichtheysoughthelp.Insomecases,themainhealthconditionwasnotstatedorunknown;costsassociatedwiththeserecordswereincludedunderthe‘Unallocated’diagnosticcategory.Basedonthesurveyformat,ifarespondentnotedthattheyhadreceivedbothformalandinformalcare,itwasnotpossibletodistinguishifthecarewasfordifferentconditions.Insuchcasesitwasassumedthatthemainhealthconditionidentifiedappliedtobothtypesofcaregiving.ResultsforthecaregivingcostsareavailableonlyattheICDchapterlevel. Results DirectCosts Aspreviouslynoted,totalcurrenthealthexpendituresinCanadain2010were$183.1 billion.Itwaspossibletoallocate$127.5 billionattheICDchapterlevel,includingexpendituresassociatedwithhospitals,prescribeddrugs,physicians,aswellasdentalservicesandvisioncareservices(seeFigure 3).Excludingdentalservicesandvisioncare,itwaspossibletoallocate$111.7 billion,or61%,ofalldirecthealthexpendituresattheEBICdiagnosticcategorylevel. Figure 3:CurrentHealthExpendituresbyUseofFunds,Canada 2010($000,000) Source:CanadianInstituteforHealthInformation(CIHI),2015 Figure 3 –Textdescription Table –Figure 3:CurrentHealthExpendituresbyUseofFunds,Canada 2010($000,000) Category Amount Percent Hospitals $56,734 31% Otherinstitutions $19,991 11% Physicians $27,445 15% Dentalservices $11,885 6% Visioncareservices $3,913 2% Otherprofessionals $3,055 2% Prescribeddrugs $27,565 15% Non-prescribeddrugs $4.842 3% Publichealth $9,847 5% Administration $5,817 3% Healthresearch $3,409 2% Other $8,557 5% DentalservicesandvisioncareservicescouldnotbeallocatedbeyondtheICDchapterlevelastherewasnodataavailableallowingfortheallocationoftheseexpenditurestoaspecificdiagnosticcategory.DentalserviceexpenditureswereallocatedentirelytoICDChapter XI,DiseasesoftheDigestiveSystem,asthischaptercoversalldentalrelatedservices.VisioncareserviceswereallocatedtoICDChapter VII,EyeandRelatedcare. Table 5showsthebreakdownofthedirectcostsbyICDchapter.Inadditiontothevaluesfromthecurrenthealthexpendituredata,formalcaregivingcostshavebeenincluded.ThecostliestICDchapterwasChapter XI,DiseasesoftheDigestiveSystemwith$19.2 billion(17%)intotalhealthexpenditures;dentalservicesaccountedforthegreatestamountoftheseexpenditures.ThenextcostliestICDchapterswereinjuries(13.5 billion,12%),diseasesofthecirculatorysystem($13.1 billion,12%),mentaldisorders($10.5 billion,9%)andmusculoskeletaldiseases($6.8 billion,6%).FootnoteoNotethateachICDchapteremploysadifferentmixofresourcesinthetreatmentoftheirrespectivediseasesorconditions.Forexample,Chapter IV(Expendituresonendocrineandrelatedconditions)andChapter V,MentalDisordersemployalargerproportionofdrugexpenditurescomparedtomanyoftheotherconditions.Chapter XXI,OtherFactors,islargelyskewedtowardshospitalexpenditures,butaswillbediscussedthisismainlyfocusedonoutpatientprocedures. Table 5:DirectCostsbyICDchapter,Canada 2010($000,000)   Hospital Physician Drugs DentalServices VisionCareServices FormalCaregiving Total I:Infectiousdiseases $1,080.4 1.9% $380.8 1.4% $792.5 2.9% 0 0 0 0 $2,253.8 2.0% II:Neoplasms $3,522.1 6.2% $1,029.5 3.8% $804.4 2.9% 0 0 $3.6 9.1% $5,359.5 4.8% III:Diseasesoftheblood $329.0 0.6% $156.8 0.6% $109.4 0.4% 0 0 0 0 $595.2 0.5% IV:Endocrineandrelated $995.4 1.8% $894.8 3.3% $3,575.9 13.0% 0 0 $0.5 1.2% $5,466.6 4.9% V:Mentaldisorders $4,137.2 7.3% $2,404.5 8.8% $3,889.4 14.1% 0 0 $8.9 22.8% $10,440.0 9.4% VI:Nervoussystem $1,474.4 2.6% $323.2 1.2% $922.9 3.3% 0 0 $9.6 24.5% $2,730.0 2.4% VII:Eyeandrelated $894.5 1.6% $1,241.3 4.5% $398.8 1.4% 0 $3,913.1 $1.0 2.5% $6,448.7 5.8% VIII:Earandrelated $315.9 0.6% $236.2 0.9% $158.7 0.6% 0 0 0 0.0% $710.8 0.6% IX:Circulatorysystem $6,128.0 10.8% $1,909.6 7.0% $4,957.3 18.0% 0 0 $5.1 13.2% $13,000.0 11.7% X:Respiratorysystem $3,142.7 5.5% $1,273.3 4.6% $2,097.3 7.6% 0 0 $0.7 1.7% $6,514.0 5.9% XI:Digestivesystem $4,399.1 7.8% $984.6 3.6% $1,915.3 6.9% $11,884.8 0 $0.6 1.6% $19,184.4 17.2% XII:Skinandrelated $535.4 0.9% $582.4 2.1% $952.9 3.5% 0 0 0 0 $2,070.7 1.9% XIII:Musculoskeletal $2,686.4 4.7% $1,382.8 5.0% $2,641.6 9.6% 0 0 $5.5 14.2% $6,716.3 6.0% XIV:Genitourinary $2,499.7 4.4% $1,312.7 4.8% $933.8 3.4% 0 0 $0.6 1.6% $4,746.8 4.3% XV:Pregnancyandchildbirth $1,831.7 3.2% $560.8 2.0% $76.7 0.3% 0 0 0 0 $2,469.2 2.2% XVI:Perinatalconditions $967.4 1.7% $97.4 0.4% $6.9 0.0% 0 0 0 0 $1,071.7 1.0% XVII:Congenitalmalformations $652.4 1.1% $69.8 0.3% $51.7 0.2% 0 0 0 0 $773.9 0.7% XVIII:Symptoms,etc. $2,588.4 4.6% $2,444.9 8.9% $1,985.4 7.2% 0 0 0 0 $7,018.6 6.3% XIXandXX:Injuries $4,038.7 7.1% $9,412.6 34.3% $416.5 1.5% 0 0 $3.0 7.6% $13,870.7 12.1% XXI:Otherfactors $14,515.1 25.6% $747.0 2.7% $877.2 3.2% 0 0 0 0 $16,139.3 14.3% Unallocated --- --- --- --- --- --- 0 0 $10.3 0 $10.3 0 Total $56,733.9 100.0% $27,445.0 100.0% $27,564.6 100.0% 0 0 $49.2 100.0% $127,590.7 100.0% Source:EBIC2010 HospitalCareExpenditures Totalhospitalcostsin2010were$56.7 billionwithinpatienttreatmentaccountingfor$29.5 billion(52%).Emergencydepartmentvisitsaccountedfor$10.7 billionofexpenditures.Overall,ICDChapter XXI(Factorsinfluencinghealthstatusandcontactwithhealthservices)accountedforover26%ofallhospital-relatedexpenditures,butonly9%ofinpatientexpenditures.Thiscategoryincludescircumstanceswherethetreatmentwasforareason otherthanadisease,injuryorexternalcause,includingregularmedicalcheck-ups.Therefore,asexpectedthischapteraccountedforthemajorityofoutpatientclinicvisits(71%).Table 6showshospitalexpendituresbyICDchapterandhealthfunction. ThecostliestICDchapters(otherthanChapter XXI)wereChapter IX,CirculatorySystemDiseases($6.1 billion,11%),Chapter XI,DigestiveSystemDiseases($4.4 billion,8%),Chapter V,MentalDisorders($4.1 billion,7%),Chapters XIXand XX,Injuries($4 billion,7%),andChapter II,Neoplasms(cancer)($3.5 billion,6%). Figure 4showsthebreakdownfortheseICDchaptersbyhealthfunction.Injuriesaccountforthelargestportionofemergencydepartmentvisitsincomparisontotheotherconditions.CirculatorysystemdiseasesemploythegreatestportionofclinicresourcesaccordingtotheEBICdata. Figure 4:CostliestICDchaptersbyhealthfunction,hospitalexpendituresonly,Canada 2010 Figure 4 –Textdescription Table –Figure 4:TotalDirectCostsbyICDChapter,Canada 2010($000,000) ICDChapter Inpatient DaySurgery EmergencyDepartment Clinic Other Total Neoplasms 2,642.9 629.2 36.5 153.9 59.7 3,522.1 Mentaldisorders 3,056.3 12.8 196.4 424.9 446.9 4,137.2 Circulatorysystem 4,521.7 344.9 250.4 810.9 200.3 6,128.0 Digestivesystem 2,242.3 1,632.4 311.9 175.4 37.2 4,399.1 Injuries 2,692.0 447.8 790.2 78.6 30.1 4,038.7 Table 6:HospitalexpendituresbyICDchapterandhealthfunction,Canada,2010($000,000)   Inpatient DaySurgery Outpatient- EmergencyDept. Outpatient- Clinic Other Total I:Infectiousdiseases $847 2.90% $44 0.60% $152 3.70% $30 0.30% $8 0.20% $1,080 1.90% II:Neoplasms $2,643 9.00% $629 8.10% $37 0.90% $154 1.40% $60 1.30% $3,522 6.20% III:Diseasesoftheblood $215 0.70% $28 0.40% $27 0.70% $57 0.50% $2 0.00% $329 0.60% IV:Endocrineandrelated $711 2.40% $33 0.40% $66 1.60% $145 1.30% $40 0.90% $995 1.80% V:Mentaldisorders $3,056 10.40% $13 0.20% $196 4.80% $425 3.90% $447 9.60% $4,137 7.30% VI:Nervoussystem $916 3.10% $82 1.10% $72 1.80% $121 1.10% $284 6.10% $1,474 2.60% VII:Eyeandrelated $31 0.10% $738 9.60% $34 0.80% $85 0.80% $6 0.10% $895 1.60% VIII:Earandrelated $55 0.20% $188 2.40% $54 1.30% $14 0.10% $4 0.10% $316 0.60% IX:Circulatorysystem $4,522 15.30% $345 4.50% $250 6.10% $811 7.50% $200 4.30% $6,128 10.80% X:Respiratorysystem $2,277 7.70% $372 4.80% $386 9.50% $80 0.70% $29 0.60% $3,143 5.50% XI:Digestivesystem $2,242 7.60% $1,632 21.10% $312 7.70% $175 1.60% $37 0.80% $4,399 7.80% XII:Skinandrelated $291 1.00% $87 1.10% $97 2.40% $43 0.40% $18 0.40% $535 0.90% XIII:Musculoskeletal $1,566 5.30% $808 10.50% $197 4.80% $82 0.80% $33 0.70% $2,686 4.70% XIV:Genitourinary $1,058 3.60% $872 11.30% $243 6.00% $276 2.60% $51 1.10% $2,500 4.40% XV:Pregnancyandchildbirth $1,498 5.10% $86 1.10% $77 1.90% $168 1.60% $3 0.10% $1,832 3.20% XVI:Perinatalconditions $952 3.20% $2 0.00% $7 0.20% $6 0.10% $2 0.00% $967 1.70% XVII:Congenitalmalformations $376 1.30% $145 1.90% $2 0.10% $118 1.10% $11 0.20% $652 1.10% XVIII:Symptoms,etc. $1,037 3.50% $283 3.70% $875 21.50% $290 2.70% $104 2.20% $2,588 4.60% XIXandXX:Injuries $2,692 9.10% $448 5.80% $790 19.40% $79 0.70% $30 0.60% $4,039 7.10% XXI:Factorsinfluencinghealth $2,496 8.50% $889 11.50% $204 5.00% $7,626 70.70% $3,301 70.70% $14,515 25.60% Total $29,482 100.00% $7,724 100.00% $4,076 100.00% $10,783 100.00% $4,670 100.00% $56,734 100.00% Source:EBIC2010 HospitalExpendituresbyAge Figure 5showsthepercentageofhospitalexpendituresacrosseachofthesixagegroupsaswellasthepercentageoftheoverallpopulation.Notsurprisingly,thoseintheolderagegroupsutilizeamuchlargerproportionofhospitalexpendituresincomparisontotheirrespectivesizeofthepopulation.Forexample,thoseaged75plusaccountedfor20percentofhospitalexpenditures,yetonlyaccountfor7%ofthepopulation.Conversely,thoseinthe15-34agegroupaccountedfor27%ofthepopulationyetonly16%ofhealthexpenditures. Figure 6showsthedistributionofallhospitalexpendituresbyhealthfunctionforeachagegroup.Itcanbeseenthatinpatientcarecomprisesagreaterproportionofhospitalexpendituresastheagegroupsincrease.Daysurgerypeaksat20%ofhospitalexpendituresforthoseaged15-34 years,whileonlyaccountingfor6%ofhospitalexpendituresinthoseaged75plus. Figure 5:Percentageofhospitalexpendituresandpopulationbyagegroup,Canada 2010 Figure 5 –Textdescription Table –Figure 5:Percentageofhospitalexpendituresandpopulationbyagegroup,Canada,2010 Agegroup Shareoftotalexpenditures Proportionofpopulation 0-14 years 13% 17% 15-34 years 16% 27% 35-54 years 23% 30% 55-64 years 15% 13% 65-74 years 13% 8% 75plus 20% 7% Figure 6:Percentageofhospitalexpendituresbyagegroupandhealthfunction,Canada 2010 Figure 6 –Textdescription Table –Figure 6:Percentageofhospitalexpendituresbyagegroupandhealthfunction,Canada 2010 Healthfunction 0-14 years 15-34 years 35-54 years 55-64 years 65-74 years 75plus Inpatient 44.0% 36.6% 40.5% 51.6% 62.1% 76.5% Daysurgery 19.0% 20.4% 15.9% 12.0% 9.6% 5.8% Emergency 7.5% 10.2% 8.2% 6.5% 5.6% 5.0% Clinic 18.7% 19.9% 24.7% 22.6% 17.7% 9.9% Other 10.8% 12.9% 10.7% 7.3% 5.0% 2.8% InpatientHospitalExpenditures Thesixconditionswiththelargestinpatienthospitalexpendituresin2010werediseasesofthecirculatorysystem($4.5 billion,15%),mentaldisorders($3.1 billion,10%),injuries($2.5 billion,9%),neoplasms($2.6 billion,8.9%),diseasesoftherespiratorysystem($2.3 billion,8%)anddiseasesofthedigestivesystem($2.2 billion,8%).Togethertheseconditionsrepresentalmost60%ofallinpatienthospitalexpenditures.Figure7showsthebreakdownforthesixcostliestICDchaptersbysex.Malesaccountedforagreateramountofexpenditures,otherthanfordigestivesystemdiseases. Figure 8showsthebreakdownofthecostliestICDchaptersbyagegroup.Expendituresfordiseasesofthecirculatorysystemincreasewithage,becomingthecostliestconditionforthoseages75 plus.Diseasesoftherespiratorysystemwerethecostliestconditionforthoseaged0-14 years,whilementaldisordersaccountedforthegreatestamountofexpendituresinthe15-34agegroup. Figure 7:Inpatienthospitalexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure 7 –Textdescription Table –Figure 7:Inpatienthospitalexpendituresbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter ExpendituresonNeoplasms ExpendituresonMentalandbehaviouraldisorders ExpendituresDiseasesofthecirculatorysystem ExpendituresonDiseasesoftherespiratorysystem ExpendituresonDiseasesofthedigestivesystem ExpendituresonInjury,poisoningandcertainotherconsequencesofexternalcauses Females 1,295 1,442 1,825 1,066 1,123 1,301 Males 1,348 1,614 2,697 1,211 1,119 1,391 Figure 8:Percentageofinpatienthospitalexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure 8 –Textdescription Table –Figure 8:Percentageofinpatienthospitalexpendituresbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 0-14 years 15-34 years 35-54 years 55-64 years 65-74 years 75plus Neoplasms 3.3% 3.1% 10.2% 13.8% 13.2% 7.8% Mentaldisorders 8.2% 21.5% 17.2% 7.5% 5.6% 6.7% Circulatorysystem 1.6% 2.2% 11.2% 20.0% 22.9% 21.6% Respiratorysystem 9.2% 2.9% 5.0% 7.5% 8.9% 10.2% Digestivesystem 4.7% 7.0% 9.9% 9.3% 7.9% 6.5% Injuries 5.5% 10.2% 10.0% 8.4% 8.0% 10.6% Other 67.5% 53.1% 36.5% 33.5% 33.4% 36.7% DaySurgeryExpenditures Thehealthconditionswiththelargestdaysurgeryexpendituresin2010weredigestivesystemdiseases($1.6 billion,21%),genitourinarydiseases($872 million,11%)musculoskeletaldiseases($808 million,11%),eyeandrelateddiseases($748 million,10%),neoplasms(629 million,8%),injuries($448 million6%);togetherwithfactorsthatinfluencehealth($889 million,12%),theseaccountedforalmost80%ofalldaysurgeryexpenditures.Notethatfemalesaccountedforagreateramountofexpendituresineachoftheseinstances,otherthaninjuries(Figure 9). Examiningthebreakdownofthecostliestconditions,byagegroup,itisevidentthateyeandrelatedconditionsrepresentthegreatestexpendituresrelatedtodaysurgeryforthoseaged75 yearsandover(37%).Digestivesystemdiseasesarethecostliestconditionforthoseintheyoungestagegroup. Figure 9:Daysurgeryexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure 9 –Textdescription Table –Figure 9:Daysurgeryexpendituresbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter Female Male Total Neoplasms 372.7 256.5 629.2 Eyeandrelated 407.2 330.5 737.7 Digestivesystem 823.3 809.1 1,632.4 Musculoskeletal 353.8 454.6 808.4 Genitourinary 603.7 268.2 871.8 Injuries 169.4 278.4 447.8 Otherfactors 487.3 401.5 888.9 Figure 10:Percentageofdaysurgeryhospitalexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure 10 –Textdescription Table –Figure 10:Percentageofdaysurgeryexpendituresbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 0-14 years 15-34 years 35-54 years 55-64 years 65-74 years 75plus Neoplasms 3.2% 4.9% 9.0% 12.7% 13.5% 12.1% Eyeandrelated 5.0% 1.6% 3.7% 12.4% 26.5% 37.1% Digestivesystem 32.1% 20.6% 20.5% 18.7% 15.2% 11.6% Musculoskeletal 5.4% 15.0% 13.5% 11.2% 6.1% 2.5% Genitourinary 6.4% 14.5% 15.8% 9.3% 7.2% 5.7% Injuries 6.3% 10.2% 5.2% 3.4% 2.3% 2.1% Other 41.5% 33.3% 32.3% 32.3% 29.2% 28.9% EmergencyDepartmentExpenditures Emergencydepartment(ED)expendituresweredominatedbytwoconditions–symptoms($875 million,22%),andinjuries($790 million,19%)whichwereresponsibleforover40%ofallEDexpenditures.Theothertopconditionswere:respiratorysystemdiseases($386 million,9.4%),digestivesystemdiseases($312 million,7.6%),diseasesofthecirculatorysystem($250 million,6.1%),genitourinarydiseases($243 million,5.9%),musculoskeletaldiseases($197 million,4.8%),andmentaldisorders($196 million,4.8%).Togethertheseconditionsaccountedfor83%ofallEDexpenditures. Figure 11showstheexpendituresforthetopconditionsbysex.FemalesaccountedforaslightlygreaterpercentageofallEDexpenditures(52%versus48%).Thisobservationisconsistentforeachoftheconditionswiththeexceptionofinjuriesandcirculatorysystemdiseases. Figure 12showsthepercentageofexpendituresbyagegroup.Thepercentageofexpendituresallocatedtosymptomswasrelativelyconstantacrossagegroups.Circulatorysystemdiseaseswereresponsibleforagrowingpercentageofexpendituresasageincreased,whileexpendituresoninjuriesfellasageincreased. Figure 11:Emergencydepartmentexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure 11 –Textdescription Table –Figure 11:Emergencydepartmentexpendituresbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter Female Male Total Circulatorysystem 117.7 132.7 250.4 Respiratorysystem 198.9 186.7 385.6 Digestivesystem 160.8 151.1 311.9 Genitourinary 161.8 81.3 243.1 Symptoms,etc. 483.8 391.2 874.9 Injuries 349.4 440.8 790.2 Other 659.1 560.5 1,219.6 Figure 12:Percentageofemergencydepartmentexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure 12 –Textdescription Table –Figure 12:Percentageofemergencydepartmentexpendituresbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 0-14 years 15-34 years 35-54 years 55-64 years 65-74 years 75plus Circulatorysystem 0.6% 1.4% 4.5% 9.1% 12.4% 14.9% Respiratorysystem 18.8% 6.8% 6.8% 8.4% 10.1% 10.3% Digestivesystem 5.1% 6.9% 8.4% 8.8% 8.7% 8.1% Genitourinary 3.6% 7.2% 6.7% 5.6% 5.3% 5.7% Symptoms,etc. 17.0% 19.3% 22.6% 23.2% 23.8% 23.9% Injuries 25.8% 23.7% 19.6% 15.9% 12.9% 14.0% OtherChapters 29.3% 34.7% 31.4% 29.0% 26.9% 23.1% DrugExpenditures In2010,prescriptiondrugexpendituresinCanadawere$27.6 billion,allofwhichwereallocatedbyEBICdiagnosticcategory,age,andsex.Thisamountrepresents85%ofalldrugsalesinCanada,withtheremainderincludingover-the-counterdrugs. Figure 13providesanoverviewofdrugexpendituresforthecostliestconditionsbysex;(endocrineandrelated,mentaldisorders,circulatorysystem,respiratorysystem,digestivesystem,musculoskeletal,andsymptoms),accountingforover76%ofallprescriptiondrugexpenditures.Theconditionswiththegreatestdrugexpendituresforfemaleswerecirculatorydiseases,mentaldisorders,andmusculoskeletal.Thetopthreeconditionsformaleswerecirculatorydiseases,endocrineandrelateddiseases,andmentaldisorders.Thegreatestcostdifferencebysexwasformusculoskeletaldiseaseswherefemaleexpenditureswerealmostdoublethatofmaleexpenditures,$1.8 billionand$0.9 billionrespectively. Figure 13:Drugexpendituresbysex,selectedICDchapter,Canada 2010($000,000) Figure 13 –Textdescription Table –Figure 13:Drugexpendituresbysex,selectedICDchapter,Canada 2010($000,000) ICDChapter Expendituresonfemales Expendituresonmales Endocrineandrelated 2,035 1,541 Mentaldisorders 1,918 1,972 Circulatorysystem 2,823 2,134 Respiratorysystem 1,018 1,079 Digestivesystem 906 1,010 Musculoskeletal 871 1,771 Symptoms,etc. 888 1,098 Figure 14showsthepercentageofdrugexpendituresandpopulationbyagegroup.Individualsaged0-14 yearsincurredthelowestpercentageofdrugexpenditures(5%).Aswiththehospitalexpenditures,thoseintheolderagegroupsutilizeamuchlargerproportionofdrugexpendituresincomparisontotheirrespectivesizeofthepopulation.Individualsaged55 yearsandolderaccountedforapproximately52%oftotaldrugexpenditures,eventhoughtheyaccountedforonly28%ofthetotalpopulation. Figure 15showsthepercentagedistributionofdrugexpendituresbyagegroupforthecostliestconditions.ThedistributionofdrugexpendituresacrossICDchaptersvariedconsiderablybyagegroup.Forexample,whilerespiratorysystemdiseasesaccountedfor32%ofdrugexpendituresforthoseaged0-14 years,theyaccountedfor10%,orless,ofexpendituresforalloftheotheragegroups.Mentaldisordersmakeupamoresignificantportionofthedrugexpendituresforthoseintheyoungeragegroupsincomparisontotheolderagegroups,whilecirculatorydiseasesrepresentthegreatestpercentageofdrugexpendituresintheolderagegroups. Figure 14:Percentageofdrugexpendituresandpopulationbyagegroup,Canada 2010 Figure 14 –Textdescription Table –Figure 14:Percentageofdrugexpendituresandpopulationbyagegroup,Canada 2010 Agegroup Proportionofpopulation Shareofexpenditures 0-14 years 17% 5% 15-34 years 27% 14% 35-65 years 30% 30% 55-64 years 13% 21% 65-74 years 8% 16% 75plus 7% 15% Figure 15:Percentageofdrugexpendituresbyagegroup,selectedICDchapters,Canada 2010 Figure 15 –Textdescription Table –Figure 15:Percentageofdrugexpendituresbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 0-14 years 15-34 years 35-54 years 55-64 years 65-74 years 75plus Endocrineandrelated 1.5% 4.1% 11.6% 19.5% 18.8% 11.8% Mentaldisorders 21.4% 23.1% 17.2% 11.9% 6.0% 9.4% Circulatorysystem 0.5% 1.5% 11.1% 22.7% 30.2% 32.1% Respiratorysystem 32.1% 10.1% 5.9% 5.4% 5.9% 5.9% Digestivesystem 4.9% 8.6% 9.3% 5.7% 5.9% 4.3% Musculoskeletal 0.3% 6.0% 11.7% 11.4% 10.4% 8.1% Symptoms,etc. 5.5% 5.4% 8.0% 7.3% 7.1% 7.9% OtherChapters 33.7% 41.1% 25.2% 16.0% 15.7% 20.5% PhysicianCareExpenditures In2010,physicianexpenditurestotalled$27.4 billion,representing14%ofallhealthexpenditures.Injuriesaccountedforthehighestlevelofphysicianexpenditures,representing33%ofallphysicianexpenditures.Thetopeightconditionswiththegreatestphysicianexpenditures(Mentaldisorders,eyeandrelatedconditions,circulatorysystem,respiratorysystem,musculoskeletal,genitourinary,symptoms,andinjuries)accountedforapproximately78%oftotalphysicianexpenditures. Figure 16showsthephysicianexpendituresforcostliestconditionsbrokendownbysex.Giventhatfemalesaccountedfor57%ofphysicianexpenditures,thefindingthatfemaleexpendituresformostconditionsweregreaterthanmaleexpendituresisnotsurprising.Note,however,thatmaleexpendituresrelatedtocirculatorysystemdiseasesweregreaterthanfemaleexpenditures. Figure 16:Physicianexpendituresbysex,selectedICDchapters,Canada 2010($000,000) Figure 16 –Textdescription Table –Figure 16:Physicianexpendituresbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter Physicianexpendituresonmales Physicianexpendituresonfemales Mentaldisorders 1,083.4 1,321.1 Eyeandrelated 545.0 696.4 Circulatorysystem 1,064.2 845.4 Respiratorysystem 608.1 665.2 Musculoskeletal 535.5 847.3 Genitourinary 446.7 866.0 Symptoms,etc. 1,091.9 1,353.0 Injuries 3,793.2 5,619.4 Figure 17showsthepercentageofphysicianexpendituresandpopulationbyagegroup.Thoseaged55 yearsandoverconsumedalargerproportionofexpenditures(49%)incomparisontotheirproportionofthepopulation(28%).ExaminingphysicianexpendituresbyICDchapterandagegroup(Figure 18),theoverallcostdistributiondoesnotchangesignificantly,otherthananincreasewithageinthepercentageofphysicianexpendituresrelatedtocirculatorydiseases. Figure 17:Percentageofphysicianexpendituresandpopulationbyagegroup,Canada 2010 Figure 17 –Textdescription Table –Figure 17:Percentageofphysicianexpendituresandpopulationbyagegroup,Canada 2010 Agegroup Proportionofpopulationbyagegroup Shareoftotalexpendituresbyagegroup 0-14 years 17% 7% 15-34 years 27% 17% 35-65 years 30% 27% 55-64 years 13% 17% 65-74 years 8% 15% 75plus 7% 19% Figure 18:Percentageofphysicianexpendituresbyagegroup,selectedICDchapters,Canada2010 Figure 18 –Textdescription Table –Figure 18:Percentageofphysicianexpendituresbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 0-14 years 15-34 years 35-54 years 55-64 years 65-74 years 75plus Mentaldisorders 7.2% 13.4% 11.7% 7.8% 4.2% 5.3% Circulatorysystem 0.7% 1.3% 4.6% 8.8% 11.3% 12.8% Respiratorysystem 16.3% 5.0% 3.9% 3.2% 3.2% 3.5% Musculoskeletal 1.2% 2.6% 4.7% 5.6% 5.6% 8.1% Symptoms,etc. 11.4% 7.7% 9.2% 9.3% 8.6% 8.7% Injuries 25.4% 35.4% 37.2% 35.6% 34.7% 30.9% Other 37.8% 34.6% 28.7% 29.6% 32.4% 30.8% IndirectCosts Thetotalvalueofindirectcostsin2010includedinEBICwas$18.9 billion.Thisincludesthevalueoflostproductionduetomorbidityandprematuremortalityaswellasthevalueofinformalcaregiving.Notethatthevalueoflostproductionduetomorbidity,whichwasestimatedat$18.2 billion,accountedforthemajorityoftheindirectcosts.Table 7showstheindirectcostsbyICDchapter.Thetoptwoconditions,injuries($3.8 billion,27%)anddiseasesoftherespiratorysystem($3.1 billion,22%)accountedforoverhalfoftheallocatedindirectcosts.Footnotep Table 7:IndirectCostsbyICDChapter,Canada,2010 ICDchapter Mortality Morbidity InformalCaregiving Total $ (000,000s) % $ (000,000s) %of allocated $ (000,000s) %of allocated $ (000,000s) %of allocated I:Infectiousdiseases 16.9 2.6 907.9 6.8 0 0 924.8 6.6 II:Neoplasms 237.8 36.4 540.0 4.1 12.3 9.3 790.2 5.6 III:Diseasesoftheblood 2.1 0.3 11.1 0.1 0 0 13.2 0.1 IV:Endocrineandrelated 24.7 3.8 184.9 1.4 5.3 4.0 214.9 1.5 V:Mentaldisorders 9.9 1.5 1,171.5 8.8 31.4 23.5 1,212.8 8.6 VI:Nervoussystem 19.3 3.0 388.1 2.9 21.7 16.3 429.2 3.1 VII:Eyeandrelated 0.0 0.0 45.6 0.3 0.9 0.7 46.4 0.3 VIII:Earandrelated 0.0 0.0 22.2 0.2 0 0 22.2 0.2 IX:Circulatorysystem 130.9 20.1 499.4 3.8 13.9 10.4 644.2 4.6 X:Respiratorysystem 23.4 3.6 3,067.4 23.1 2.7 2.0 3,093.5 22.0 XI:Digestivesystem 34.7 5.3 323.0 2.4 3.4 2.6 361.1 2.6 XII:Skinandrelated 0.6 0.1 20.8 0.2 0 0 21.4 0.2 XIII:Musculoskeletal 3.4 0.5 1,959.0 14.8 22.3 16.7 1,984.6 14.1 XIV:Genitourinary 5.8 0.9 336.3 2.5 1.6 1.2 343.7 2.4 XV:Pregnancyandchildbirth 0.2 0.0 25.0 0.2 0 0 25.2 0.2 XVI:Perinatalconditions 0.0 0.0 0 0.0 0 0 0.0 0.0 XVII:Congenitalmalformations 4.4 0.7 14.0 0.1 0 0 18.3 0.1 XVIII:Symptoms,etc. 9.0 1.4 86.0 0.6 0 0 95.0 0.7 XIXandXX:Injuries 129.6 19.8 3,658.8 27.6 17.7 13.3 3,806.0 27.1 XXI:Otherfactors 0 0 8.6 0.1 0 0 8.6 0.1 Unallocated 0 0 4,894.5 0 23.9 0 4,918.4 0 Total 652.9 100.0 18,164.1 100.0 157.1 100.0 18,974.0 100.0 Source:EBIC2010 ValueofLostProductionduetoMorbidity Thevalueoflostproductionduetomorbiditywasestimatedat$18.2 billion,ofwhichitwaspossibletoallocate$13.3 billion,or73%,byICDchapter.Thefivemostexpensiveconditionswereinjuries($3.7 billion,28%),diseasesoftherespiratorysystem($3.1 billion,23%),diseasesofthemusculoskeletalsystem($2 billion,15%),mentaldisorders($1.2 billion,9%),andinfectiousdiseases($908 million,7%).Together,theseconditionswereresponsiblefor81%ofallocatedmorbiditycosts.Footnoteq Totalmorbiditycostswerehigherformales($9.8 billion,53.7%)thanforfemales($8.4 billion,46.3%).Figure 19illustratesthecostestimatesofthevalueoflostproductionduetomorbiditybysexforthefivecostliestconditions.Theproportionofcostsattributabletomalesandfemalesvariesconsiderablybycondition.Forexample,morbiditycostsduetoinjuriesweremorethandoubleformalescomparedtofemales($2.5 billionversus$1.1 billion). Figure 19:Morbiditycostsbysex,selectedICDchapters,Canada 2010($000,000) Figure 19 –Textdescription Table –Figure 19:Morbiditycostsbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter MorbiditycostsforFemales,millionsofdollars MorbiditycostsforMales,millionsofdollars Infectiousdiseases 460.34 447.60 Mentaldisorders 594.58 576.92 Respiratory 1,420.01 1,647.43 Musculoskeletal 1,060.27 898.76 Injuries 1,144.53 2,514.23 Figure 20illustratesthepercentageofthevalueoflostproductionduetomorbidityandthepercentageofpopulationbyagegroup.Thoseinthe35-54agegrouphadthehighestshareofexpenditurescomparedtotheirshareoftheoverallpopulation.Individualsaged35-54 yearsincurredthehighestpercentageofmorbiditycosts($10.7 billion,59.0%).Thisisaresultofthisgroupbeingthemostlikelytobeemployedandwiththehighestearnings(usedtovaluelostproduction),withahigherprevalenceofdisability. Figure 21illustratesthepercentageofthevalueoflostproductionduetomorbiditybyagegroupforthesixcostliestICDchapters.TheICDchapterswiththehighestpercentageofmorbiditycostswerediseasesoftherespiratorysystemforthoseaged15-34 yearsandinjuriesforthetwootheragegroups. Figure 20:Percentageofmorbiditycostsandpopulationbyagegroup,Canada 2010 Figure 20 –Textdescription Table –Figure 20:Percentageofmorbiditycostsandpopulationbyagegroup,Canada 2010 Agegroup Proportionofpopulation Proportionofexpenditures 15-34 35% 23% 35-54 38% 59% 55-64 27% 18% Figure 21:Percentageofmorbiditycostsbyagegroup,selectedICDchapters,Canada 2010 Figure 21 –Textdescription Table –Figure 21:Percentageofmorbiditycostsbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 15-34 years 35-54 years 55-74 years Infectiousdiseases 7.7% 4.3% 3.8% Mentaldisorders 6.7% 7.2% 3.8% Respiratorysystem 22.2% 16.1% 12.7% Musculoskeletal 6.0% 11.7% 13.9% Injuries 20.0% 18.8% 24.7% OtherChapters 37.4% 41.9% 41.1% ValueofLostProductionduetoPrematureMortality In2010,thevalueoflostproductionduetoprematuremortalitywasestimatedat$653 million.Thecostliestconditionswere:neoplasms($238 million,36%),diseasesofthecirculatorysystem($131 million,20%),injuries($130 million,20%),digestivesystemdiseases($35 million,5%),endocrineandrelateddiseases($25 million,4%),anddiseasesofrespiratorysystem($23 million,4%).Thesesixconditionsaccountedfor90%ofthetotalvalueoflostproductionduetomortality,withthetopthreeconditionsaccountingforoverthree-quartersofthecosts.Totalmortalitycostswerehigherformales($480.6 million,73.6%)thanforfemales($172.3 million,26.4%).Figure 22illustratesthevalueoflostproductionduetoprematuremortality,bysex,forthesixcostliestconditions. Figure 22:Prematuremortalitycostsbysex,selectedICDchapters,Canada 2010($000,000) Figure 22 –Textdescription Table –Figure 22:Prematuremortalitycostsbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter MortalitycostsforFemales,millionsofdollars MortalitycostsforMales,millionsofdollars Neoplasms 86.68 151.15 Endocrineandrelated 5.55 19.14 Diseasesofthecirculatorysystem 22.12 108.82 Respiratorysystem 6.81 16.55 Digestivesystem 7.83 26.88 Injuries 23.52 106.05 Figure 23illustratesthepercentagevalueoflostproductionduetoprematuremortalityandpopulationbyagegroup.Individualsaged35-54 yearsincurredthehighestpercentageofmortalitycosts(51%,$333.7 million)andindividualsaged15-34 yearsincurredthelowestpercentageofmortalitycosts(7%,$44.2 million)eventhoughtheyaccountedforalmost39%ofthepopulation. Figure 24illustratesthepercentagevalueoflostproductionduetomortalitybyagegroupforthesixcostliestICDchapters.Forindividualsaged15-34 years,thehighestpercentageofmortalitycostswereforinjuries(62%)andlowestfordiseasesoftherespiratorysystem(1%).Intheoldestagegroup(55-64 years)thepercentageofmortalitycostsattributabletoneoplasmsanddiseasesofthecirculatorysystemaccountedforthegreatestpercentageofexpendituresat45%and24%,respectively. Figure 23:Percentageofprematuremortalitycostsandpopulationbyagegroup,Canada 2010 Figure 23 –Textdescription Table –Figure 23:Percentageofprematuremortalitycostsandpopulationbyagegroup,Canada 2010 Agegroup Proportionofpopulation Proportionofexpenditures 15-34 39% 7% 35-54 43% 51% 55-64 18% 42% Figure 24:Percentageofprematuremortalitycostsbyagegroup,selectedICDchapters,Canada 2010 Figure 24 –Textdescription Table –Figure 24:Percentageofprematuremortalitycostsbyagegroup,selectedICDchapters,Canada 2010 ICDChapter Proportionoftotalcostforthe15-34 yearolds Proportionoftotalcostforthe35-54 yearolds Proportionoftotalcostforthe55-64 yearolds Neoplasms 12.7% 32.8% 44.6% Endocrineandrelated 2.6% 3.6% 4.2% Circulatorysystem 6.5% 18.9% 23.7% Respiratorysystem 1.5% 3.0% 4.7% Digestivesystem 2.2% 5.7% 5.3% Injuries 62.5% 24.2% 7.8% OtherChapters 12.2% 11.9% 9.7% CaregivingCosts In2010,thetotalvalueofcaregivingwas$206 million;formalcaregivingwasvaluedat$49 million,whileinformalcaregivingwasvaluedat$157 million.Theformerwasincludedasadirectcost(asdirectpaymentsweremadefortheservices),whilethelatterwasincludedasanindirectcost.Inthissection,theresultsfrombothtypesofcaregivingarepresented. Mentaldisorderswereresponsibleforthegreatestvalueofcaregivingcostsat$40 million.Thenextcostliestconditionswerenervoussystemdisorders,musculoskeletaldiseases,injuries,diseasesofthecirculatorysystem,andneoplasms.Figure 25illustratesthecaregivingcostsbytype,forthesixcostliestconditions,whichwereresponsiblefor90%oftheallocatedcostsassociatedwithcaregiving. Figure 25:Caregivingcostsbytype,selectedICDchapters,Canada 2010($000,000) Figure 25 –Textdescription Table –Figure 25:Caregivingcostsbytype,selectedICDchapters,Canada 2010($000,000) ICDChapter Informal Formal Total Neoplasms 12.3 3.6 15.9 Mentaldisorders 31.4 8.9 40.2 Nervoussystem 21.7 9.6 31.3 Circulatorysystem 13.9 5.1 19.0 Musculoskeletal 22.3 5.5 27.8 Injuries 17.7 3.0 20.7 Totalcaregivingcostswerehigherforfemales($125.9 million,61.0%)thanformales($80.4 million,39.0%).Figure 26showsthetotalcaregivingcostsbysexforthesixcostliestICDchapters.Menonlyhavehighercosts,comparedtofemales,forinjuriesandmentaldisorders. Figure 26:Totalcaregivingcostsbysex,selectedICDchapters,Canada 2010($000,000) Figure 26 –Textdescription Table –Figure 26:Totalcaregivingcostsbysex,selectedICDchapters,Canada 2010($000,000) ICDChapter Male Female Total Neoplasms 4 12 16 Mentaldisorders 20 20 40 Nervoussystem 12 20 31 Circulatorysystem 8 11 19 Musculoskeletal 8 19 28 Injuries 11 10 21 Figure 27illustratesthepercentageoftotalcaregivingcostsandthepercentageofthepopulationbyagegroup.Individualsaged75 yearsandmoreincurredthehighestpercentageofcaregivingcosts(29%,$59 million),howeverthoseaged15-54accountedforalmosthalfofthecaregivingcosts.Ofnote,isthatforthetwooldestagegroupsthepercentageofcostsisgreaterthantheirproportionofthepopulation.Forexample,thoseaged75 yearsandmoreaccountforonly8%ofthepopulationwhileincurring29%ofthetotalcaregivingcosts. Figure 28illustratesthepercentageoftotalcaregivingcostsbyagegroupforthefiveconditionswiththehighestcost.FootnoterForindividualsaged15-34 years,thehighestpercentageofthecaregivingcostswereformentalandbehaviouraldisorders(57%).Injuriesrepresentedthegreatestpercentageofcaregivingcostsforthoseaged35-54 years(23%),whilenervoussystemdisorders(19%)werethegreatestcontributortocaregivingcostsforthoseaged55andgreater. Figure 27:Percentageoftotalcaregivingcostsandpopulationbyagegroup,Canada 2010 Figure 27 –Textdescription Table –Figure 27:Percentageoftotalcaregivingcostsandpopulationbyagegroup,Canada 2010 Agegroup Expenditures Population 15-34 years 24.64% 39.07% 35-54 years 22.63% 42.84% 55-74 years 52.73% 18.10% Figure 28:Percentageoftotalcaregivingcostsbyagegroup,selectedICDchapters,Canada 2010 Figure 28 –Textdescription Table –Figure 28:Percentageoftotalcaregivingcostsbyagegroup,selectedICDchapters,Canada 2010 ICDChapter 15-34 years 35-54 years 55-74 years Mentaldisorders 56.80% 14.74% 4.13% Nervoussystem 12.20% 10.18% 18.70% Circulatorysystem 3.62% 3.49% 14.30% Musculoskeletal 4.50% 18.61% 15.46% Injuries 6.02% 23.17% 6.25% OtherChapters 16.87% 29.82% 41.16% TotalCosts Table 8showsthetotalcostsbyICDchapterandcostcomponent,includingdentalcareandvisioncare.TheinclusionofdentalservicesresultsinCh.XI,DiseasesoftheDigestiveSystembeingthecostliestICDchapteraccountingfor15%($19.6 billion)ofthetotalcostsderivedinEBIC.ThenextsixcostliestICDchapterswere:Ch.XXI,Injuries($18.6 billion,14%),Ch.XXI,FactorsInfluencingHealthStatusandContactwithHealthServices($15.3 billion,12%),Ch.IX,DiseasesoftheCirculatorySystem($13.6 billion,10%),Ch.X,DiseasesoftheRespiratorySystem($9.6 billion,7%),andCh.XIII,MusculoskeletalDiseases($8.7 billion7%). Table 8:TotalEBICCosts,Canada,2010($000,000) ICDchapter Direct Indirect Total I:Infectiousdiseases $2,254 2.00% $925 4.90% $3,179 2.40% II:Neoplasms $5,360 4.80% $790 4.20% $6,150 4.70% III:Diseasesoftheblood $595 0.50% $13 0.10% $608 0.50% IV:Endocrineandrelated $5,467 4.90% $215 1.10% $5,682 4.30% V:Mentaldisorders $10,440 9.30% $1,213 6.40% $11,653 8.90% VI:Nervoussystem $2,730 2.40% $429 2.30% $3,159 2.40% VII:Eyeandrelated $6,449 5.80% $46 0.20% $6,495 5.00% VIII:Earandrelated $711 0.60% $22 0.10% $733 0.60% IX:Circulatorysystem $13,000 11.60% $644 3.40% $13,644 10.40% X:Respiratorysystem $6,514 5.80% $3,094 16.30% $9,608 7.30% XI:Digestivesystem $19,185 17.20% $361 1.90% $19,546 14.90% XII:Skinandrelated $2,071 1.90% $21 0.10% $2,092 1.60% XIII:Musculoskeletal $6,716 6.00% $1,985 10.50% $8,701 6.70% XIV:Genitourinary $4,747 4.20% $344 1.80% $5,091 3.90% XV:Pregnancyandchildbirth $2,469 2.20% $25 0.10% $2,494 1.90% XVI:Perinatalconditions $1,072 1.00% $0 0.00% $1,072 0.80% XVII:Congenitalmalformations $774 0.70% $18 0.10% $792 0.60% XVIII:Symptoms,etc. $7,019 6.30% $95 0.50% $7,114 5.40% XIXandXX:Injuries $14,748 13.20% $3,806 20.10% $18,554 14.20% XXI:Otherfactors $15,262 13.70% $9 0.00% $15,271 11.70% Unallocated $10 0.00% $4,918 25.90% $4,929 3.80% Total $111,793 100.00% $18,974 100.00% $130,767 100.00% Source:EBIC2010 Figure 29showsthepercentageofdirectandindirectcostsinrelationtothetotalcostsfortheICDchapterswiththegreatestpercentageofindirectcosts.Indirectcostsaremostsignificantforrespiratorysystemdiseases(32%)andinfectiousdiseases(29%).GiventhatthedegreetowhichtheindirectcostsvaryacrosstheICDchapters,itisimportantthattheyareconsideredwhenexaminingcost-of-illnessandparticularlyineconomicevaluationstoensurethatthefullsocietalburdenisconsideredindecisionmaking.Themethodologyemployed(i.e.usingthefrictioncostmethod)andnotbeingabletoconsiderthefullextentofpossibleindirectcosts,alsoassuresthattheestimatesproducedareconservativeones.Inaddition,EBICdoesnotincludeanyhealthoutcomes,orthecostsassociatedwithpain,suffering,andlife.Thus,whileEBICdoesprovidedatathatbringsusclosertothefullsocietalcostsassociatedwithdiseaseandinjury,itdoesnotyetprovidethewholepicture. Figure 29:Percentageofdirectandindirectcostscomparedtototalcosts,Canada,2010 Figure 29 –Textdescription Table –Figure 29:PercentageofDirectandIndirectCostscomparedtoTotalCosts,Canada,2010 ICDChapter DirectCosts IndirectCosts Infectiousdiseases 71% 29% Neoplasms 87% 13% Mentaldisorders 90% 10% Nervoussystem 86% 14% Respiratorysystem 68% 32% Musculoskeletal 77% 23% Injuries 79% 21% Limitations Sincefirstbeingpublishedin1991,EBIChasseenchangestodatasourcesandmethodseitherinresponsetodevelopmentsinCOImethodologyorinresponsetouserand/orstakeholderneeds. ThemostobviouschangeoverthedifferenteditionsofEBICrelatestothediagnosticcategoriesemployed.EBIC2010allocatesexpendituresbyICDchapterand185diagnosticcategorieswhicharebasedupontheISHMT.ThischangewillensurethatavailabledataisgroupedinwaysthataremeaningfultotheCanadianaudience.ItisalsoinaccordancewithrecentguidelinesproducedbytheOECD,andwillhelpensureinternationalcomparability.However,thechangeindiagnosticcategoriesaffectstheabilitytodrawcomparisonsacrossthedifferentversionsofEBIC.Whileattemptshavebeenmadetomakediagnosticcategoriesascomparableaspossible,usersarecautionedagainstcomparingresultsacrossyearsandtonotethatsomedifferencesmaybeattributabletothechangesincategories,ormethods,ratherthananychangesinactualresourceutilization. Itisalsoimportanttonotethatthecostsattributedtoanydiseaseordiagnosticcategorydoesnotreflectthetotaleconomicburdenassociatedwiththatdisease.Asnotallexpenditurescouldbeallocatedtoaspecificdiagnosticcategory,itmaybemoreappropriatetoexaminethepercentageofallocatedexpendituresassignedtoeachdiagnosticcategory.This,however,assumesthatthedistributionofnon-allocatedexpenditureswouldbesimilartothatoftheallocatedexpenditures. EBIC2010estimatesarebasedonawidearrayofdatasources,includingdifferentlevelsofinformation.Datawasnotalwaysavailableforallprovincesandinmanycaseshadtobeestimatedbasedondistributionsfromotherregionsorjurisdictions.Datasourcesalsoincludedadministrativedataaswellassurveydataaffectingtheprecisionoftheresults.Mostofthedirectcostswerebasedonactualexpendituredata,however,thedirectcaregivingcostswerebasedonsurveydata,resultingindifferentlevelsofquality.Wehaveendeavoured,however,toallocatethedatatotheappropriatecostcategorybasedontheoveralldefinitions.Alsonotethatphysiciandatawasnotavailableforallprovinces/territories,andgivensignificantdemographicdifferencesacrossjurisdictionscautionshouldalsobeemployedinanalyzingtheseresults. Oneofthebenefitsofusingatop-downapproachtoallocatehealthexpendituresbydisease,ageandsexisthatallexpendituresareallocatedtodifferentdiseasegroupsinamutuallyexclusivemanner,thusavoidinganyissuesofdoublecounting.However,aresultofthisapproachmayalsobetheunder-estimationofthecostsassociatedwithcertaindiseaseswhichmaybeassociatedwithotherco-morbidconditionsormayberiskfactorsforotherconditions.Forexample,diabetes,whichhasauniqueICD-10code,isknowntocontributetootherdiseasessuchascardiovasculardisease.Thus,whenestimatingthefullcosts,orimpact,ofsuchdisease,oneshouldalsoconsidertheassociatedco-morbidconditions.Thiscanbeachievedbyemployingpopulationattributablefractions(e.g.ConferenceBoard,2017) Reference38. Aspreviouslynoted,thelaboureffectsassociatedwithillnessandinjuryincludingdecreasedproductivity,lowerwages,decreasedworkingyears,andothermacroeconomiceffectshavenotbeenfullymodelledinEBIC.Inaddition,theuseofthefrictioncostmethodinthevaluationofmortalitycostsalsopresentsaconservativeestimate.Therefore,EBICshouldbeconsideredasalowerboundofthecostassociatedwithillnessandinjury. References Reference1 Wigle,D.T.,Y.Mao,T.WongandR.Lane,EconomicBurdenofIllnessinCanada,1986,ChronicDisCan,vol.12,no.Suppl3,pp.1-37,1991. Returntoreference1referrer Reference2 PublicHealthAgencyofCanada,EconomicBurdenofIllnessinCanada,2005-2008.PHAC,Ottawa,2014. Returntoreference2referrer Reference3 Moore,R.,Y.Mao,J.ZhangandK.Clarke,EconomicBurdenofIllnessinCanada,1993.HealthCanada,Ottawa,1997. Returntoreference3referrer Reference4 HealthCanada,EconomicBurdenofIllnessinCanada,1998.HealthCanada,Ottawa,2002. 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Returntoreference40referrer Appendix:EBICDiagnosticCategories ICDChapter EBICCode ISHMTcode EBICDiagnosticCategory ICD‑10Code I 100 100 Certaininfectiousandparasiticdiseases A00‑B99 I 101 101 Clostridiumdifficile A04.7 I 102 101 Intestinalinfectiousdiseasesexceptdiarrhoea(andC.difficile) A00‑A08(exceptA04.7) I 103 102 Diarrhoeaandgastroenteritisofpresumedinfectiousorigin A09 I 104 103 Tuberculosis A15‑A19,B90 I 105 104 Septicaemia A40‑A41 I 106 105 Humanimmunodeficiencyvirus[HIV]disease B20‑B24 I 107 106 SexuallyTransmittedDiseases A50‑A64 I 108 106 Otherinfectiousandparasiticdiseases remainderofA00‑B99 II 200 200 Neoplasms C00‑D48 II 201 209 Malignantneoplasmsoflip,oralcavityandpharynx C00‑C14 II 202 209 Malignantneoplasmofesophagus C15 II 203 209 Malignantneoplasmofstomach C16 II 204 201 Malignantneoplasmofcolon,rectumandanus C18‑C21 II 205 209 Malignantneoplasmofliver C22.0,C22.2‑C22.7 II 206 209 Malignantneoplasmofpancreas C25 II 207 209 Malignantneoplasmoflarynx C32 II 208 202 Malignantneoplasmsoftrachea,bronchusandlung C33‑C34 II 209 203 Malignantneoplasmsofskin‑Melanoma C43 II 210 203 Malignantneoplasmsofskin‑Other C44 II 211 204 Malignantneoplasmofbreast C50 II 212 205 Malignantneoplasmofuterus‑Cervixuteri C53 II 213 205 Malignantneoplasmofuterus‑Other C54‑C55 II 214 206 Malignantneoplasmofovary C56 II 215 207 Malignantneoplasmofprostate C61 II 216 209 Malignantneoplasmoftestis C62 II 217 209 Malignantneoplasmofkidney C64‑C65 II 218 208 Malignantneoplasmofbladder C67 II 219 209 Malignantneoplasmofbrain C70‑C72 II 220 209 Malignantneoplasmofthyroid C73 II 221 209 Hodgkinlymphoma C81 II 222 209 Non‑Hodgkinlymphoma C82‑C85,C96.3 II 223 209 Multiplemyeloma C90.0,C90.2 II 224 209 Leukaemia C90.1,C91‑C95 II 225 209 Othermalignantneoplasms remainderofC00‑C97 II 226 210 Carcinomainsitu D00‑D09 II 227 211 Benignneoplasmofcolon,rectumandanus D12 II 228 212 Leiomyomaofuterus D25 II 229 213 Otherbenignneoplasmsandneoplasmsofuncertainorunknownbehaviour remainderofD00‑D48 III 300 300 Diseasesofthebloodandbloodformingorgansandcertaindisordersinvolvingtheimmunemechanism D50‑D89 III 301 301 Anaemias‑Iron‑deficiencyanaemia D50 III 302 301 Anaemias‑Other D51‑D64 III 303 302 Otherdiseasesofthebloodandbloodformingorgansandcertaindisordersinvolvingtheimmunemechanism D65‑D89 IV 400 400 Endocrine,nutritionalandmetabolicdiseases E00‑E90 IV 401 401 Diabetesmellitus E10‑E14 IV 402 402 Otherendocrine,nutritionalandmetabolicdiseases remainderofE00‑E90 V 500 500 Mentalandbehaviouraldisorders F00‑F99 V 501 501 Dementia F00‑F03 V 502 502 Mentalandbehaviouraldisordersduetoalcohol F10 V 503 503 Mentalandbehaviouraldisordersduetouseofotherpsychoactivesubst. F11‑F19 V 504 504 Schizophrenia,schizotypalanddelusionaldisorders F20‑F29 V 505 505 Mood[affective]disorders F30‑F39 V 506 506 Othermentalandbehaviouraldisorders remainderofF00‑F99 VI 600 600 Diseasesofthenervoussystem G00‑G99 VI 601 601 Alzheimer'sdisease G30 VI 602 602 Multiplesclerosis G35 VI 603 603 Epilepsy G40‑G41 VI 604 604 Transientcerebralischaemicattacksandrelatedsyndromes G45 VI 605 605 Bacterialmeningitis G00 VI 606 605 Meningitisduetootherorganismsorofunspecifiedcause G03 VI 607 605 Parkinsondiseaseandsecondaryparkinsonism G20‑G21 VI 608 605 Migraine G43 VI 609 605 Otherdiseasesofthenervoussystem remainderofG00‑G99 VII 700 700 Diseasesoftheeyeandadnexa H00‑H59 VII 701 701 Cataract H25‑H26,H28 VII 702 702 Otherdiseasesoftheeyeandadnexa remainderofH00‑H59 VIII 800 800 Diseasesoftheearandmastoidprocess H60‑H95 VIII 801 800 Otitismedia H65‑H66 VIII 802 800 Hearingloss H90‑H91 VIII 803 800 Otherdiseasesoftheearandmastoidprocess remainderofH60‑H95 IX 900 900 Diseasesofthecirculatorysystem I00‑I99 IX 901 901 Essentialhypertension I10 IX 902 901 Otherhypertensivediseases I11‑I13,I15 IX 903 902 Anginapectoris I20 IX 904 903 Acutemyocardialinfarction I21‑I22 IX 905 904 Otherischaemicheartdiseases I23‑I25 IX 906 905 Pulmonaryheartdisease&diseasesofpulmonarycirculation I26‑I28 IX 907 906 Conductiondisordersandcardiacarrhythmias I44‑I49 IX 908 907 Heartfailure I50 IX 909 908 Cerebralinfarction I63 IX 910 908 Subarachnoidhaemorrhage I60 IX 911 908 Intracerebralhaemorrhage I61 IX 912 908 Acutebutill‑definedstroke I64 IX 913 908 Othercerebrovasculardiseases I62,I65‑I69 IX 914 909 Atherosclerosis I70 IX 915 910 Varicoseveinsoflowerextremities I83 IX 916 911 Otherdiseasesofthecirculatorysystem remainderofI00‑I99 X 1000 1000 Diseasesoftherespiratorysystem J00‑J99 X 1001 1001 Influenza J09‑J11 X 1002 1001 Otheracuteupperrespiratoryinfections J00‑J06 X 1003 1002 Pneumonia J12‑J18 X 1004 1003 Otheracutelowerrespiratoryinfections J20‑J22 X 1005 1004 Chronicdiseasesoftonsilsandadenoids J35 X 1006 1005 Otherdiseasesofupperrespiratorytract J30‑J34,J36‑J39 X 1007 1006 Chronicobstructivepulmonarydisease J40‑J44 X 1008 1006 Bronchiectasis J47 X 1009 1007 Asthma J45‑J46 X 1010 1008 Otherdiseasesoftherespiratorysystem J60‑J99 XI 1100 1100 Diseasesofthedigestivesystem K00‑K93 XI 1101 1101 Diseasesoftheteethandsupportingstructures K00‑K08 XI 1102 1102 Otherdiseasesoforalcavity,salivaryglandsandjaws K09‑K14 XI 1103 1103 Diseasesofoesophagus K20‑K23 XI 1104 1104 Pepticulcer K25‑K28 XI 1105 1105 Dyspepsiaandotherdiseasesofstomachandduodenum K29‑K31 XI 1106 1106 Diseasesofappendix K35‑K38 XI 1107 1107 Inguinalhernia K40 XI 1108 1108 Otherabdominalhernia K41‑K46 XI 1109 1109 Crohn'sdiseaseandulcerativecolitis K50‑K51 XI 1110 1110 Othernoninfectivegastroenteritisandcolitis K52 XI 1111 1111 Paralyticileusandintestinalobstructionwithouthernia K56 XI 1112 1112 Diverticulardiseaseofintestine K57 XI 1113 1113 Diseasesofanusandrectum K60‑K62 XI 1114 1114 Otherdiseasesofintestine K55,K58‑K59,K63 XI 1115 1115 Alcoholicliverdisease K70 XI 1116 1116 Fibrosisandcirrhosisofliver K74 XI 1117 1117 Otherdiseasesofliver K71‑K73,K75‑K77 XI 1118 1118 Cholelithiasis K80 XI 1119 1119 Otherdiseasesofgallbladderandbiliarytract K81‑K83 XI 1120 1120 Diseasesofpancreas K85‑K87 XI 1121 1121 Otherdiseasesofthedigestivesystem remainderofK00‑K93 XII 1200 1200 Diseasesoftheskinandsubcutaneoustissue L00‑L99 XII 1201 1201 Infectionsoftheskinandsubcutaneoustissue L00‑L08 XII 1202 1202 Dermatitis,eczemaandpapulosquamousdisorders L20‑L45 XII 1203 1203 Otherdiseasesoftheskinandsubcutaneoustissue remainderofL00‑L99 XIII 1300 1300 Diseasesofthemusculoskeletalsystemandconnectivetissue M00‑M99 XIII 1301 1301 Coxarthrosis[arthrosisofhip] M16 XIII 1302 1302 Gonarthrosis[arthrosisofknee] M17 XIII 1303 1303 Internalderangementofknee M23 XIII 1304 1304 Otherarthrosis M15,M18‑M19 XIII 1305 1304 Rheumatoidarthritis M05‑M06 XIII 1306 1304 Gout M10 XIII 1307 1304 Otherarthropathies M00‑M03,M07‑M09,M11‑M14,M20‑M22,M24‑M25 XIII 1308 1305 Systemicconnectivetissuedisorders M30‑M36 XIII 1309 1306 Deformingdorsopathiesandspondylopathies M40‑M49 XIII 1310 1307 Intervertebraldiscdisorders M50‑M51 XIII 1311 1308 Dorsalgia M54 XIII 1312 1309 Softtissuedisorders M60‑M79 XIII 1313 1310 Osteoporosis M80,M81 XIII 1314 1310 Otherdisordersofthemusculoskeletalsystemandconnectivetissue M53,M80‑M99 XIV 1400 1400 Diseasesofthegenitourinarysystem N00‑N99 XIV 1401 1401 Glomerularandrenaltubulo‑interstitialdiseases N00‑N16 XIV 1402 1402 Acuterenalfailure N17 XIV 1403 1402 Chronicrenalfailure N18 XIV 1404 1402 Unspecifiedrenalfailure N19 XIV 1405 1403 Urolithiasis N20‑N23 XIV 1406 1404 Otherdiseasesoftheurinarysystem N25‑N39 XIV 1407 1405 Hyperplasiaofprostate N40 XIV 1408 1406 Otherdiseasesofmalegenitalorgans N41‑N51 XIV 1409 1407 Disordersofbreast N60‑N64 XIV 1410 1408 Inflammatorydiseasesoffemalepelvicorgans N70‑N77 XIV 1411 1409 Menstrual,menopausalandotherfemalegenitalconditions N91‑N95 XIV 1412 1410 Otherdisordersofthegenitourinarysystem remainderofN00‑N99 XV 1500 1500 Pregnancy,childbirthandthepuerperium O00‑O99 XV 1501 1501 Medicalabortion O04 XV 1502 1502 Otherpregnancywithabortiveoutcome O00‑O03,O05‑O08 XV 1503 1503 Oedema,proteinuriaandhypertensivedisordersinpregnancy,childbirthandthepuerperium O10‑O16 XV 1504 1503 Othercomplicationsofpregnancypredominantlyintheantenatalperiod O20‑O48 XV 1505 1504 Obstructedlabour(Dystocia) O64‑O66 XV 1506 1504 Othercomplicationsofpregnancypredominantlyduringlabouranddelivery O67‑O75 XV 1507 1505 Singlespontaneousdelivery O80 XV 1508 1506 Otherdelivery O81‑O84 XV 1509 1507 MaternalSepsis O85‑O86 XV 1510 1507 Othercomplicationspredominantlyrelatedtothepuerperium O87‑O92 XV 1511 1508 Otherobstetricconditions O94,O95‑O99 XVI 1600 1600 Certainconditionsoriginatingintheperinatalperiod P00‑P96 XVI 1601 1601 Disordersrelatedtoshortgestationandlowbirthweight P07 XVI 1602 1602 Slowfetalgrowthandfetalmalnutrition P05 XVI 1603 1602 Birthasphyxiaandbirthtrauma P03,P10‑P15,P20‑P29 XVI 1604 1602 Otherconditionsoriginatingintheperinatalperiod remainderofP00‑P96 XVII 1700 1700 Congenitalmalformations,deformationsandchromosomalabnormalities Q00‑Q99 XVII 1701 1700 Congenitalheartanomalies Q20‑Q28 XVII 1702 1700 Othercongenitalmalformations,deformationsandchromosomalabnormalities remainderofQ00‑Q99 XVIII 1800 1800 Symptoms,signsandabnormalclinicalandlaboratoryfindings,notelsewhereclassified R00‑R99 XVIII 1801 1801 Paininthroatandchest R07 XVIII 1802 1802 Abdominalandpelvicpain R10 XVIII 1803 1803 Unknownandunspecifiedcausesofmorbidity(incl.thosewithoutadiagnosis) R69 XVIII 1804 1804 Othersymptoms,signsandabnormalclinicalandlaboratoryfindings remainderofR00‑R99 XIX 1900 1900 Injury,poisoningandcertainotherconsequencesofexternalcauses(Injurycodingtype 1)Appendixnotea S00‑T98 XIX 1901 1901 Intracranialinjury S06 XIX 1902 1902 Otherinjuriestothehead S00‑S05,S07‑S09 XIX 1903 1903 Fractureofforearm S52 XIX 1904 1904 Fractureoffemur S72 XIX 1905 1905 Fractureoflowerleg,includingankle S82 XIX 1906 1906 Otherinjuries S10‑S51,S53‑S71,S73‑S81,S83‑T14,T79 XIX 1907 1907 Burnsandcorrosions T20‑T32 XIX 1908 1908 Poisoningsbydrugs,medicamentsandbiologicalsubstancesandtoxiceffectsofsubstanceschieflynonmedicinalastosource T36‑T65 XIX 1909 1909 Complicationsofsurgicalandmedicalcare,notelsewhereclassified T80‑T88 XIX 1910 1910 Sequelaeofinjuries,ofpoisoningandofotherconsequencesofexternalcauses T90‑T98 XIX 1911 1911 Otherandunspecifiedeffectsofexternalcauses remainderofS00‑T98 XX 2000 n/a Externalcausesofmorbidityandmortality(Injurycodingtype 2)Appendixnotea V01‑Y98 XX 2001 n/a Roadtrafficaccidents V01‑V06fourthdigits1‑9(exampleV01.1,V01.2,V01.3etc.);V09.2;V09.3;V10,V11,V15‑V18&V29‑V79fourthdigits4‑9;V12‑V14&V20‑V28fourthdigits3‑9;V19.4‑V19.6;V80.3‑V80.5;V81.1;V82.1;V83‑V86fourthdigits0‑3;V87.0‑V87.8,V89.2;V89.9;V99;Y85.0 XX 2002 n/a Poisonings X40‑X49 XX 2003 n/a Falls W00‑W19 XX 2004 n/a Fires X00‑X09 XX 2005 n/a Drowning W65‑W74 XX 2006 n/a Otherunintentionalinjuries RestofV,W20‑W64,W75‑W99,X10‑X39,X50‑X59,Y40‑Y86(minusY85.0),Y88,Y89(minusY89.9) XX 2007 n/a Self‑inflictedinjuries X60‑X84,Y87.0 XX 2008 n/a Violence X85‑Y09,Y87.1 XX 2009 n/a Otherintentionalinjuries Y35,Y36 XX 2010 n/a Injuriesofundeterminedintent Y10‑Y34,Y87.2,Y89.9 XXI 2100 2100 Factorsinfluencinghealthstatusandcontactwithhealthservices Z00‑Z99 XXI 2101 2101 Medicalobservationandevaluationforsuspecteddiseasesandconditions Z03 XXI 2102 2102 Contraceptivemanagement Z30 XXI 2103 2103 Liveborninfantsaccordingtoplaceofbirth("healthynewbornbabies") Z38 XXI 2104 2104 Othermedicalcare(includingradiotherapyandchemotherapysessions) Z51 XXI 2105 2105 Otherfactorsinfluencinghealthstatusandcontactwithhealthservices remainderofZ00‑Z99 Appendixnotea Notethattheoriginatingdataforthedirectcosts(hospital,drug,andphysician)classifiedinjuriesaccordingtoICDChapter XIX,Injury,poisoningandcertainotherconsequencesofexternalcauses(Injurycodingtype 1).Mortalitycosts,associatedwithinjuries,arebasedonVitalStatisticsdataandwerecodedonlytoICDChapter XX,Externalcausesofmorbidityandmortality(Injurycodingtype 2).WhenestimatingthetotalcostsassociatedwithinjuriesitisnecessarytoincludebothICDchapters. ReturntoAppendixnoteareferrer Footnotes Footnote1 RecentexamplesofEBICorsimilardatabeingemployedincludeConferenceBoardofCanada ReferencealandOECD(2014) Reference40. Returntofootnoteareferrer Footnote2 DentalServices,VisionCareServices,FormalCaregivingandMorbidityCostswereonlyallocatedattheICDchapterlevel. Returntofootnotebreferrer Footnote3 DaysurgeryrecordsforOntarioandAlbertawerecapturedinNACRS,whiledaysurgeryrecordsforNovaScotiaarecontainedinboththeDADandNACRS.QuebecdoesnotreportdaysurgeryrecordstotheDADorNACRS. Returntofootnotecreferrer Footnote4 ThesecategoriescorrespondtotheSHAcategoriesHC.1.1&HC.2.1(inpatientcurativeandrehabilitativecare),HC.1.2&HC.2.2(daycurativeandrehabilitativecare),andHC.1.3&HC.2.3(outpatientcurativeandrehabilitativecare).The“othercategoryincludesHC1.4&HC.2.4(Home-basedcurativeandrehabilitativecare),Long-termcare(HC.3),AncillaryServices(HC.4)andPreventivecare(HC.6) Returntofootnotedreferrer Footnote5 ThiscorrespondstoSHAcategoryHP.1Hospitals Returntofootnoteereferrer Footnote6 WhichalsoincludeAPPexpenditures,aswellsasspendingbyMunicipalGovernments,SocialSecurityFundsandtheFederalGovernmentforphysicianexpenditures. Returntofootnotefreferrer Footnote7 Thetypesofproductionlossesareslightlymorenuancedandmayalsoincludecompensationmechanismsandmultipliereffects.SeeKroletal(2013)forfurtherdetailsonvaluingproductioncosts. Returntofootnotegreferrer Footnote8 Individualswhoindicatedmissedworkdaysduetoillnessandinjurybuthadnotworkedinthepast12 monthswereexcludedfromanalysis. Returntofootnotehreferrer Footnote9 Individualslessthan15 yearsandmorethan75 yearsofagewereexcludedfromparticipationintheCCHSLOPmodule,astheseindividualswereconsideredunlikelytobeworkingandthuswouldhavenolostproductionfromlabourmarketactivities. Returntofootnoteireferrer Footnote10 Notethatmortalitycostsendattheageof64.Thedataemployedtoestimatethevalueoflostproductionduetomorbidityincludedindividualsuptoageof75.Hencetheagegroupsemployeddonotexactlymatch. Returntofootnotejreferrer Footnote11 Iftheprovider’ssexwasunknown,province-agespecificearningswereused.Ifagewasunknown,province-sexspecificearningswereused.Ifsexandagewereunknownprovincialspecificearningswereused. Returntofootnotekreferrer Footnote12 Forinformalcaregiving,ifthecareproviderwasidentifiedas19 yearsoryounger,theywereassignedtheearningsfortheagegroup‘lessthan20 years’(15-19 years). Returntofootnotelreferrer Footnote13 Forbothformalandinformalcaregiving,itwasassumedthattheprovinceoftherespondent(caregivingreceiver)wasthesameasthecaregivingprovidersincetheprovider’sprovincewasnotasked. Returntofootnotemreferrer Footnote14 Earningsincludewages,salaries,commissionsandself-employmentincome. Returntofootnotenreferrer Footnote15 ThisexcludesChapter XXI,FactorsinfluencinghealthstatusandcontactwithhealthservicesastheseICDcodesrefertothereasonforwhichtheencounteroccurredratherthantheactualdisease,ordiagnosisitself. Returntofootnoteoreferrer Footnote16 Ashasbeennoted,notalloftheindirectcostscouldbeallocated.Notethatthepercentagevaluesnotedinthissectionrefertothepercentageofallocatedcostsastheseresultsaremoremeaningful. Returntofootnote16referrer Footnote17 Thesefiguresrefertothepercentageofallocatedcosts,ratherthanthepercentageofallcosts. Returntofootnotepreferrer Footnote18 AgegroupshavebeencombinedduetosmallcellsizesthatoccurwhenthedataisbrokendownbyICDchapter. 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